Provider Demographics
NPI:1841979416
Name:FREEMAN, KYLE LEWIS (DC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:LEWIS
Last Name:FREEMAN
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 1:34 TROUPE RD
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-8369
Mailing Address - Country:US
Mailing Address - Phone:814-558-9891
Mailing Address - Fax:
Practice Address - Street 1:181 ROUTE 6 W
Practice Address - Street 2:
Practice Address - City:COUDERSPORT
Practice Address - State:PA
Practice Address - Zip Code:16915-8462
Practice Address - Country:US
Practice Address - Phone:814-558-9891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor