Provider Demographics
NPI:1154712164
Name:MACPHERSON, KYLE (DC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MACPHERSON
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 1:2423 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3632
Mailing Address - Country:US
Mailing Address - Phone:304-723-5340
Mailing Address - Fax:304-723-0438
Practice Address - Street 1:2423 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3632
Practice Address - Country:US
Practice Address - Phone:304-723-5340
Practice Address - Fax:304-723-0438
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor