Provider Demographics
NPI:1871866756
Name:DAIGLE, KYLE ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ANTHONY
Last Name:DAIGLE
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:PO BOX 4610
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-4610
Mailing Address - Country:US
Mailing Address - Phone:337-529-0653
Mailing Address - Fax:337-312-1490
Practice Address - Street 1:313 ALAMO STREET
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8528
Practice Address - Country:US
Practice Address - Phone:337-529-0653
Practice Address - Fax:337-312-1490
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor