Provider Demographics
NPI:1841470721
Name:NEELEY, KYLE KENDALL (NMD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:KENDALL
Last Name:NEELEY
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 E FORT LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1110
Mailing Address - Country:US
Mailing Address - Phone:520-326-9355
Mailing Address - Fax:520-795-1445
Practice Address - Street 1:4635 E FORT LOWELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1110
Practice Address - Country:US
Practice Address - Phone:520-326-9355
Practice Address - Fax:520-795-1445
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05-897175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath