Provider Demographics
NPI:1811260920
Name:WARREN, KYLE (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:WARREN
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 1:3800 AMERICAN BLVD W
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-4420
Mailing Address - Country:US
Mailing Address - Phone:952-921-5858
Mailing Address - Fax:888-502-1176
Practice Address - Street 1:3800 AMERICAN BLVD W
Practice Address - Street 2:SUITE 1500
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-4420
Practice Address - Country:US
Practice Address - Phone:952-921-5858
Practice Address - Fax:888-502-1176
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5495111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition