Provider Demographics
NPI:1649636259
Name:KYLE M MCKAMEY DC PLLC
Entity type:Organization
Organization Name:KYLE M MCKAMEY DC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCKAMEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-462-9464
Mailing Address - Street 1:75354 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-1677
Mailing Address - Country:US
Mailing Address - Phone:269-462-9464
Mailing Address - Fax:269-462-9692
Practice Address - Street 1:114 COMMERCIAL ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-1727
Practice Address - Country:US
Practice Address - Phone:269-462-9464
Practice Address - Fax:269-462-9692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty