Individual
DR. KYLE RICHARD IKAIKA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
4001 MAIN ST STE 200, VANCOUVER, WA 98663-1894
(360) 693-3030
Mailing address
13518 SE BUSH ST, PORTLAND, OR 97236-3373
(808) 754-0580
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
61129517
WA
Other
Enumeration date
01/02/2021
Last updated
01/02/2021
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