Provider Demographics
NPI:1619390283
Name:KURSCHEIDT, KYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:KURSCHEIDT
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 1:1825 SE 164TH AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8602
Mailing Address - Country:US
Mailing Address - Phone:360-524-7677
Mailing Address - Fax:360-326-1668
Practice Address - Street 1:1825 SE 164TH AVE STE 118
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-8602
Practice Address - Country:US
Practice Address - Phone:360-524-7677
Practice Address - Fax:360-326-1668
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-01
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH6079144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty