Provider Demographics
NPI:1629610886
Name:UNRUH, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:UNRUH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23160 ALBION AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3610
Mailing Address - Country:US
Mailing Address - Phone:616-238-1667
Mailing Address - Fax:
Practice Address - Street 1:30900 FORD RD STE C
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1892
Practice Address - Country:US
Practice Address - Phone:734-838-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor