Provider Demographics
NPI:1811888688
Name:BERRY, KYLE CLEVELAND (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:CLEVELAND
Last Name:BERRY
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 1:911 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4010
Mailing Address - Country:US
Mailing Address - Phone:303-718-9683
Mailing Address - Fax:
Practice Address - Street 1:8631 W ARDENE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2601
Practice Address - Country:US
Practice Address - Phone:208-629-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8861778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor