Provider Demographics
NPI:1548543754
Name:ELLENSOHN, KYLE MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:MATTHEW
Last Name:ELLENSOHN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:208 S MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213-1416
Mailing Address - Country:US
Mailing Address - Phone:641-342-2122
Mailing Address - Fax:641-342-2119
Practice Address - Street 1:6110 NW 86TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2257
Practice Address - Country:US
Practice Address - Phone:515-276-4946
Practice Address - Fax:515-276-6535
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2016-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA007424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor