Individual
DR. KYLE STANLEY DEDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
611 BRIGHTON AVE, PORTLAND, ME 04102-2322
(207) 773-4651
(207) 773-8940
Mailing address
611 BRIGHTON AVE, PORTLAND, ME 04102-2322
(207) 773-4651
(207) 773-8940
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
06446
IA
111N00000X
Chiropractor
Primary
CR2084
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0463422
—
IA
01
—
39100
WELLMARK NUMBER
IA
Enumeration date
09/25/2006
Last updated
02/22/2014
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