Provider Demographics
NPI:1215967807
Name:YOUNGER, KYLE R (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:R
Last Name:YOUNGER
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 1:1016 S LINDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2334
Mailing Address - Country:US
Mailing Address - Phone:913-908-1302
Mailing Address - Fax:913-402-7450
Practice Address - Street 1:11960 QUIVIRA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2222
Practice Address - Country:US
Practice Address - Phone:913-402-7444
Practice Address - Fax:913-402-7450
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS9408529OtherPHCS PROVIDER
KS35511019OtherBC/BS PROVIDER NO.
KS9408529OtherPHCS PROVIDER