Provider Demographics
NPI:1326126616
Name:LYTELL, KATHRYN LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LYNN
Last Name:LYTELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3468 SE DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997
Mailing Address - Country:US
Mailing Address - Phone:772-463-4833
Mailing Address - Fax:772-463-3653
Practice Address - Street 1:3468 SE DIXIE HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997
Practice Address - Country:US
Practice Address - Phone:772-463-4833
Practice Address - Fax:772-463-3653
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T64310Medicare UPIN
22858Medicare PIN
22858Medicare ID - Type Unspecified