Provider Demographics
NPI:1437998911
Name:ORDILLE, KYLE THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:THOMAS
Last Name:ORDILLE
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 1:171 3RD AVE APT C
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-3673
Mailing Address - Country:US
Mailing Address - Phone:717-743-7138
Mailing Address - Fax:
Practice Address - Street 1:907 HOUSTON NORTHCUTT BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3448
Practice Address - Country:US
Practice Address - Phone:717-743-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor