Provider Demographics
NPI:1497143655
Name:HART, MICHAEL KYLE (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KYLE
Last Name:HART
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:P.O. BOX 476
Mailing Address - Street 2:
Mailing Address - City:NORTH TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24630
Mailing Address - Country:US
Mailing Address - Phone:276-988-4265
Mailing Address - Fax:276-988-4152
Practice Address - Street 1:699 EAST RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24630
Practice Address - Country:US
Practice Address - Phone:276-988-4265
Practice Address - Fax:276-988-4152
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor