Provider Demographics
NPI:1710198064
Name:LYTER, KEVIN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:LYTER
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 1:1720 S 72ND ST
Mailing Address - Street 2:STE 102
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-1245
Mailing Address - Country:US
Mailing Address - Phone:253-472-4424
Mailing Address - Fax:253-471-9806
Practice Address - Street 1:1720 S 72ND ST
Practice Address - Street 2:STE 102
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1245
Practice Address - Country:US
Practice Address - Phone:253-472-4424
Practice Address - Fax:253-471-9806
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH33945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0151168OtherLABOR AND INDUSTRIES
WAAB33532Medicare ID - Type UnspecifiedMEDICARE