Provider Demographics
NPI:1215952403
Name:WERKHEISER, KYLE BARRY (DC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:BARRY
Last Name:WERKHEISER
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 1:224 NAZARETH PIKE
Mailing Address - Street 2:SUITE 19
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-9080
Mailing Address - Country:US
Mailing Address - Phone:610-746-3332
Mailing Address - Fax:610-746-3381
Practice Address - Street 1:224 NAZARETH PIKE
Practice Address - Street 2:SUITE 19
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9080
Practice Address - Country:US
Practice Address - Phone:610-746-3332
Practice Address - Fax:610-746-3381
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007931L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3658019OtherAETNA #
PA01999301OtherASHN #
PA1651035OtherBLUE SHIELD #
PA3658019OtherAETNA #
PA1651035OtherBLUE SHIELD #