Provider Demographics
NPI:1427338334
Name:BOLAND, KYLE DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DAVID
Last Name:BOLAND
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:N4622 COUNTY ROAD M
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-9522
Mailing Address - Country:US
Mailing Address - Phone:608-612-0777
Mailing Address - Fax:608-807-5142
Practice Address - Street 1:N4622 COUNTY ROAD M
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-9522
Practice Address - Country:US
Practice Address - Phone:608-612-0777
Practice Address - Fax:608-807-5142
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011984111N00000X
IA007563111N00000X
WI4770012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1427338334OtherINDIVIDUAL NPI
WIWI3185001Medicare PIN