Provider Demographics
NPI:1376894600
Name:STATES, KYLE L (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:L
Last Name:STATES
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 1:65 TIMBER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1148
Mailing Address - Country:US
Mailing Address - Phone:405-613-2918
Mailing Address - Fax:405-275-3210
Practice Address - Street 1:65 TIMBER CREEK DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1148
Practice Address - Country:US
Practice Address - Phone:405-613-2918
Practice Address - Fax:405-275-3210
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor