Provider Demographics
NPI:1588001184
Name:POTTER, KYLE A (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:A
Last Name:POTTER
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 1:2749 PEMBROOK PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-7482
Mailing Address - Country:US
Mailing Address - Phone:785-537-2211
Mailing Address - Fax:785-537-3811
Practice Address - Street 1:2749 PEMBROOK PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-7482
Practice Address - Country:US
Practice Address - Phone:785-537-2211
Practice Address - Fax:785-537-3811
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33677111N00000X
KS0105548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor