Provider Demographics
NPI:1447320452
Name:KYLE, BRANDY LYNNE (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:LYNNE
Last Name:KYLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CAVE SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6429
Mailing Address - Country:US
Mailing Address - Phone:636-441-4000
Mailing Address - Fax:363-441-4468
Practice Address - Street 1:1004 CAVE SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6429
Practice Address - Country:US
Practice Address - Phone:636-441-4000
Practice Address - Fax:363-441-4468
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005003281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO199235OtherBLUE CROSS BLUE SHIELD