Provider Demographics
NPI:1902905474
Name:MORAN, KYLE PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:PATRICK
Last Name:MORAN
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 1:4908 MONUMENT AVENUE
Mailing Address - Street 2:100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3613
Mailing Address - Country:US
Mailing Address - Phone:804-254-0200
Mailing Address - Fax:804-254-1953
Practice Address - Street 1:4908 MONUMENT AVENUE
Practice Address - Street 2:100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3613
Practice Address - Country:US
Practice Address - Phone:804-254-0200
Practice Address - Fax:804-254-1953
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6730229OtherACN