Provider Demographics
NPI:1861162661
Name:KANIUK, KYLE (DC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:KANIUK
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 1:13720 N CLEVELAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4300
Mailing Address - Country:US
Mailing Address - Phone:239-997-8100
Mailing Address - Fax:239-997-4817
Practice Address - Street 1:13720 N CLEVELAND AVE STE B
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4300
Practice Address - Country:US
Practice Address - Phone:239-997-8100
Practice Address - Fax:239-997-4817
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor