Provider Demographics
NPI:1760712244
Name:BUESTETON, KYLE ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ANTHONY
Last Name:BUESTETON
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 1:231 E. DELMAR
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002
Mailing Address - Country:US
Mailing Address - Phone:618-462-6630
Mailing Address - Fax:618-462-6640
Practice Address - Street 1:231 E. DELMAR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5935
Practice Address - Country:US
Practice Address - Phone:618-462-6630
Practice Address - Fax:618-462-6640
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor