Provider Demographics
NPI:1619198538
Name:STULL, KYLE WYATT (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WYATT
Last Name:STULL
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 1:7123 W Q AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5951
Mailing Address - Country:US
Mailing Address - Phone:269-353-7440
Mailing Address - Fax:
Practice Address - Street 1:7123 W Q AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5951
Practice Address - Country:US
Practice Address - Phone:269-353-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP18570Medicare ID - Type Unspecified