Provider Demographics
NPI:1194280628
Name:WARNER, KYLE SAMUEL
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:SAMUEL
Last Name:WARNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10815 W JEWELL AVE STE P
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-6268
Mailing Address - Country:US
Mailing Address - Phone:303-980-1378
Mailing Address - Fax:303-980-1379
Practice Address - Street 1:10815 W JEWELL AVE STE P
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-6268
Practice Address - Country:US
Practice Address - Phone:303-980-1378
Practice Address - Fax:303-980-1379
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor