Provider Demographics
NPI:1700056082
Name:GILMOUR, KYLE BRIAN (DC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:BRIAN
Last Name:GILMOUR
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 1:7867 CONVOY CT
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1214
Mailing Address - Country:US
Mailing Address - Phone:858-715-1962
Mailing Address - Fax:858-715-1969
Practice Address - Street 1:7867 CONVOY CT
Practice Address - Street 2:SUITE 306
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1214
Practice Address - Country:US
Practice Address - Phone:858-715-1962
Practice Address - Fax:858-715-1969
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU81638Medicare UPIN