Provider Demographics
NPI:1295136000
Name:BEAN, KYLE J (DC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:J
Last Name:BEAN
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 1:1171 E PUTNAM AVE
Mailing Address - Street 2:BUILDING #2
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1426
Mailing Address - Country:US
Mailing Address - Phone:203-637-1325
Mailing Address - Fax:
Practice Address - Street 1:1171 E PUTNAM AVE
Practice Address - Street 2:BUILDING #2
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1426
Practice Address - Country:US
Practice Address - Phone:203-637-1325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1993111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology