Provider Demographics
NPI:1427521558
Name:DEIMLER, KYLE WITMER (DC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:WITMER
Last Name:DEIMLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KYLE
Other - Middle Name:WITMER
Other - Last Name:DEIMLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:223 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17074-1421
Mailing Address - Country:US
Mailing Address - Phone:717-982-7196
Mailing Address - Fax:
Practice Address - Street 1:223 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074-1421
Practice Address - Country:US
Practice Address - Phone:717-567-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADC011468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program