Provider Demographics
NPI:1801304852
Name:WALSH, KYLE NOLAN (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:NOLAN
Last Name:WALSH
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 1:33 AVON ST S APT 6
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3186
Mailing Address - Country:US
Mailing Address - Phone:630-667-3786
Mailing Address - Fax:
Practice Address - Street 1:33 AVON ST S APT 6
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3186
Practice Address - Country:US
Practice Address - Phone:630-667-3786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor