Provider Demographics
NPI:1518619931
Name:BOWER, KYLE THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:THOMAS
Last Name:BOWER
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 1:604 EAST MADISON DRIVE
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226-4718
Mailing Address - Country:US
Mailing Address - Phone:515-953-9360
Mailing Address - Fax:
Practice Address - Street 1:2675 N ANKENY BLVD STE 115
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4719
Practice Address - Country:US
Practice Address - Phone:515-207-2748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA110318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor