Provider Demographics
NPI:1417462631
Name:LEDUC, KYLE ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ANTHONY
Last Name:LEDUC
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 1:5101 THIMSEN AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4153
Mailing Address - Country:US
Mailing Address - Phone:952-232-4700
Mailing Address - Fax:952-232-4699
Practice Address - Street 1:5101 THIMSEN AVE STE 106
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4153
Practice Address - Country:US
Practice Address - Phone:952-232-4700
Practice Address - Fax:952-232-4699
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor