Provider Demographics
NPI:1124899653
Name:WILLIAMS, KYLE MATTHEW (DC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:MATTHEW
Last Name:WILLIAMS
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 1:105 N PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9129
Mailing Address - Country:US
Mailing Address - Phone:360-666-6001
Mailing Address - Fax:360-666-6002
Practice Address - Street 1:105 N PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9129
Practice Address - Country:US
Practice Address - Phone:360-666-6001
Practice Address - Fax:360-666-6002
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61484920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor