Provider Demographics
NPI:1336372887
Name:GULLEDGE, KYLE VINCENT (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:VINCENT
Last Name:GULLEDGE
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 1:11107 W 115TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3417
Mailing Address - Country:US
Mailing Address - Phone:913-481-1322
Mailing Address - Fax:
Practice Address - Street 1:11879 W 112TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2725
Practice Address - Country:US
Practice Address - Phone:913-338-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor