Provider Demographics
NPI:1952331621
Name:BORRETT, KYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:BORRETT
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 1:209 S EVANS RD
Mailing Address - Street 2:
Mailing Address - City:EVANSDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50707-1121
Mailing Address - Country:US
Mailing Address - Phone:319-234-4872
Mailing Address - Fax:319-236-0670
Practice Address - Street 1:209 S EVANS RD
Practice Address - Street 2:
Practice Address - City:EVANSDALE
Practice Address - State:IA
Practice Address - Zip Code:50707-1121
Practice Address - Country:US
Practice Address - Phone:319-234-4872
Practice Address - Fax:319-236-0670
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1185306Medicaid
IA1185306Medicaid
IA47903Medicare ID - Type Unspecified