Provider Demographics
NPI:1588749782
Name:BUCKLE, KYLE WILFRED PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WILFRED PATRICK
Last Name:BUCKLE
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 1:38807 ANN ARBOR RD STE 5
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3896
Mailing Address - Country:US
Mailing Address - Phone:734-953-9933
Mailing Address - Fax:
Practice Address - Street 1:38807 ANN ARBOR RD STE 5
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3896
Practice Address - Country:US
Practice Address - Phone:734-953-9933
Practice Address - Fax:734-953-9966
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP47220001Medicare PIN