Provider Demographics
NPI:1588977219
Name:TRUE, KYLE A (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:A
Last Name:TRUE
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 1:3070 S WALNUT ST
Mailing Address - Street 2:#B
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-7333
Mailing Address - Country:US
Mailing Address - Phone:812-287-8281
Mailing Address - Fax:
Practice Address - Street 1:3070 S WALNUT ST
Practice Address - Street 2:#B
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-7333
Practice Address - Country:US
Practice Address - Phone:812-287-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8159111N00000X
IN08002585A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1750646998OtherTAX ID - CLINIC
IN08002585AOtherSTATE LICENSE