Provider Demographics
NPI:1801221361
Name:HANES, KYLE ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ALEXANDER
Last Name:HANES
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 1:116 PONCE DE LEON AVE NE
Mailing Address - Street 2:#2319
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-4113
Mailing Address - Country:US
Mailing Address - Phone:706-536-4165
Mailing Address - Fax:
Practice Address - Street 1:814 JUNIPER ST NE
Practice Address - Street 2:SUITE 201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1300
Practice Address - Country:US
Practice Address - Phone:678-439-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor