Provider Demographics
NPI:1801167192
Name:ROESLER, KYLE ALDERSON (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ALDERSON
Last Name:ROESLER
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 1:9449 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3130
Mailing Address - Country:US
Mailing Address - Phone:314-432-2220
Mailing Address - Fax:314-432-8161
Practice Address - Street 1:9449 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3130
Practice Address - Country:US
Practice Address - Phone:314-432-2220
Practice Address - Fax:314-432-8161
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012000065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor