Provider Demographics
NPI:1740838713
Name:DIRCK, KYLE (DC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:DIRCK
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 1:2525 KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3546
Mailing Address - Country:US
Mailing Address - Phone:563-344-0777
Mailing Address - Fax:
Practice Address - Street 1:2525 KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3546
Practice Address - Country:US
Practice Address - Phone:563-344-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor