Provider Demographics
NPI:1730466772
Name:DEFREITAS, KYLE RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:RYAN
Last Name:DEFREITAS
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 1:200 MARKET PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3272
Mailing Address - Country:US
Mailing Address - Phone:972-966-3333
Mailing Address - Fax:972-966-3339
Practice Address - Street 1:200 MARKET PL
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-3272
Practice Address - Country:US
Practice Address - Phone:972-316-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor