Provider Demographics
NPI:1811386949
Name:SMITH, KYLE WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:WILLIAM
Last Name:SMITH
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 1:436 OLD SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3904
Mailing Address - Country:US
Mailing Address - Phone:985-641-4898
Mailing Address - Fax:985-641-8060
Practice Address - Street 1:436 OLD SPANISH TRL
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3904
Practice Address - Country:US
Practice Address - Phone:985-641-4898
Practice Address - Fax:985-641-8060
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor