Provider Demographics
NPI:1780128561
Name:CRESS, KYLIE MISHAY (DC)
Entity type:Individual
Prefix:DR
First Name:KYLIE
Middle Name:MISHAY
Last Name:CRESS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MADISON AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-6693
Mailing Address - Country:US
Mailing Address - Phone:715-204-4223
Mailing Address - Fax:
Practice Address - Street 1:1500 MADISON AVE STE 205
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-6693
Practice Address - Country:US
Practice Address - Phone:715-204-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1304111N00000X
WI5550-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor