Provider Demographics
NPI:1356449763
Name:DOAN, KYLE WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WILLIAM
Last Name:DOAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 BOATHOUSE CIR
Mailing Address - Street 2:# 234
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8924
Mailing Address - Country:US
Mailing Address - Phone:941-957-8148
Mailing Address - Fax:941-957-8148
Practice Address - Street 1:7725 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5313
Practice Address - Country:US
Practice Address - Phone:941-957-8148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD5501Medicare ID - Type Unspecified