Provider Demographics
NPI:1467492199
Name:KLEINFELTER, KYRIE E (DC)
Entity Type:Individual
Prefix:
First Name:KYRIE
Middle Name:E
Last Name:KLEINFELTER
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 1:1750 E MAIN ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2363
Mailing Address - Country:US
Mailing Address - Phone:630-584-5200
Mailing Address - Fax:630-584-8370
Practice Address - Street 1:1750 E MAIN ST
Practice Address - Street 2:SUITE 140
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2363
Practice Address - Country:US
Practice Address - Phone:630-584-5200
Practice Address - Fax:630-584-8370
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202498Medicare ID - Type Unspecified