Provider Demographics
NPI:1376798900
Name:DANA, KYLE WESTEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WESTEN
Last Name:DANA
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 1:1351 E LINDA LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5316
Mailing Address - Country:US
Mailing Address - Phone:480-353-1719
Mailing Address - Fax:
Practice Address - Street 1:1351 E LINDA LN
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5316
Practice Address - Country:US
Practice Address - Phone:480-353-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ139058242T00000X
AZ7978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
No111N00000XChiropractic ProvidersChiropractor