Provider Demographics
NPI:1013462837
Name:HEIMER, KYLE THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:THOMAS
Last Name:HEIMER
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 1:1203 F OLD TROLLEY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5296
Mailing Address - Country:US
Mailing Address - Phone:843-486-0999
Mailing Address - Fax:843-486-0989
Practice Address - Street 1:1203 F OLD TROLLEY RD
Practice Address - Street 2:SUITE B
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5296
Practice Address - Country:US
Practice Address - Phone:843-486-0999
Practice Address - Fax:843-486-0989
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor