Provider Demographics
NPI:1609052729
Name:SCHMITZ, KYLE G (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:G
Last Name:SCHMITZ
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 1:1502 PREHISTORIC HILL DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-2288
Mailing Address - Country:US
Mailing Address - Phone:636-464-8828
Mailing Address - Fax:636-464-8838
Practice Address - Street 1:1502 PREHISTORIC HILL DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-2288
Practice Address - Country:US
Practice Address - Phone:636-464-8828
Practice Address - Fax:636-464-8838
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008001515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor