Provider Demographics
NPI:1558029421
Name:NICKOL, KYLE DAVID (DC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:DAVID
Last Name:NICKOL
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 1:827 N LAST CHANCE GULCH
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3318
Mailing Address - Country:US
Mailing Address - Phone:406-449-4445
Mailing Address - Fax:406-495-0259
Practice Address - Street 1:827 N LAST CHANCE GULCH
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3318
Practice Address - Country:US
Practice Address - Phone:406-449-4445
Practice Address - Fax:406-495-0259
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-7381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor