Provider Demographics
NPI:1487948196
Name:CEYNAR, KYLE ROBERT (DC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ROBERT
Last Name:CEYNAR
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 1:2315 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3411
Mailing Address - Country:US
Mailing Address - Phone:701-572-8796
Mailing Address - Fax:701-774-0555
Practice Address - Street 1:2315 2ND AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3411
Practice Address - Country:US
Practice Address - Phone:701-572-8796
Practice Address - Fax:701-774-0555
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor