Provider Demographics
NPI:1336444983
Name:KLIM, KYLE BRANDON (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:BRANDON
Last Name:KLIM
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 1:130 W MAIN ST
Mailing Address - Street 2:SWEDE FAMILY CHIROPRACTIC
Mailing Address - City:TRAPPE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2025
Mailing Address - Country:US
Mailing Address - Phone:610-831-1650
Mailing Address - Fax:610-831-1651
Practice Address - Street 1:130 W MAIN ST
Practice Address - Street 2:SWEDE FAMILY CHIROPRACTIC
Practice Address - City:TRAPPE
Practice Address - State:PA
Practice Address - Zip Code:19426-2025
Practice Address - Country:US
Practice Address - Phone:610-831-1650
Practice Address - Fax:610-831-1651
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010391111N00000X
PAAJ010191111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1932329752OtherTYPE II GRP NPI