Provider Demographics
NPI:1639189731
Name:VONDEYLEN, KYLE W (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:W
Last Name:VONDEYLEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1630 BUFORD HWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3629
Mailing Address - Country:US
Mailing Address - Phone:770-945-0561
Mailing Address - Fax:770-945-0517
Practice Address - Street 1:1630 BUFORD HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3629
Practice Address - Country:US
Practice Address - Phone:770-945-0561
Practice Address - Fax:770-945-0517
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3751111N00000X
GACHIR008492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor