Provider Demographics
NPI:1073298972
Name:DEPOLLAR, KYLE (DC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:DEPOLLAR
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 1:2 BETHANY FOREST DR
Mailing Address - Street 2:
Mailing Address - City:DAGSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19939-9218
Mailing Address - Country:US
Mailing Address - Phone:301-789-8768
Mailing Address - Fax:
Practice Address - Street 1:98 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:DE
Practice Address - Zip Code:19970-9715
Practice Address - Country:US
Practice Address - Phone:302-319-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0011112111N00000X
GACHIR010986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor