Provider Demographics
NPI:1952648362
Name:NEVILL, KYLE WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WAYNE
Last Name:NEVILL
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 1:2700 W LAWRENCE AVE
Mailing Address - Street 2:SUITE J-4
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1181
Mailing Address - Country:US
Mailing Address - Phone:217-546-6698
Mailing Address - Fax:217-546-4487
Practice Address - Street 1:2700 W LAWRENCE AVE
Practice Address - Street 2:SUITE J-4
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1181
Practice Address - Country:US
Practice Address - Phone:217-546-6698
Practice Address - Fax:217-546-4487
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor