Provider Demographics
NPI:1851956437
Name:FENTON, KYLE (DC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:FENTON
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 1:9150 GLENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1364
Mailing Address - Country:US
Mailing Address - Phone:913-385-1999
Mailing Address - Fax:
Practice Address - Street 1:9150 GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1364
Practice Address - Country:US
Practice Address - Phone:913-385-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor