Provider Demographics
NPI:1255461596
Name:KIFER, KYLE K (DC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:K
Last Name:KIFER
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 1:4200 N RODNEY PARHAM RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2458
Mailing Address - Country:US
Mailing Address - Phone:501-661-0336
Mailing Address - Fax:501-661-0412
Practice Address - Street 1:4200 N RODNEY PARHAM RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2461
Practice Address - Country:US
Practice Address - Phone:501-661-0336
Practice Address - Fax:501-661-0412
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A307Medicare PIN