Provider Demographics
NPI:1215115183
Name:EGNER, KYLE DARYL (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DARYL
Last Name:EGNER
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 1:619 OLD SYMSONIA RD STE B
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-5094
Mailing Address - Country:US
Mailing Address - Phone:270-703-7431
Mailing Address - Fax:270-527-0505
Practice Address - Street 1:619 OLD SYMSONIA RD STE B
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-5094
Practice Address - Country:US
Practice Address - Phone:270-527-3050
Practice Address - Fax:270-527-0505
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor