Provider Demographics
NPI:1386875284
Name:WALTZ, KYLE EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:EDWARD
Last Name:WALTZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1341 E MOREHEAD ST
Mailing Address - Street 2:STE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2936
Mailing Address - Country:US
Mailing Address - Phone:704-940-7740
Mailing Address - Fax:704-243-8403
Practice Address - Street 1:1341 E MOREHEAD ST
Practice Address - Street 2:STE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2936
Practice Address - Country:US
Practice Address - Phone:704-940-7740
Practice Address - Fax:704-843-8403
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1539111N00000X
NC3977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor