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Individual

DR. KYLE WELLINGTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
275 EVANGELINE AVE, LOUISVILLE, KY 40214-3007
(502) 368-9914
Mailing address
275 EVANGELINE AVE, LOUISVILLE, KY 40214-3007
(502) 368-9914

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4955
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000580921
ANTHEM BLUE CROSS BLUE SHIELD
KY
01
11470848
CAQH PROVIDER #
KY
05
7100050180
KY
Enumeration date
06/09/2006
Last updated
11/30/2015
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