DR. KYLE STANLEY DEDEN (NPI# 1366542532) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366542532 |
| Entity Type | Individual |
| Full Name | DR. KYLE STANLEY DEDEN |
| Credential | D.C. |
| Practice Address |
611 Brighton Ave Portland ME 04102-2322 |
| Practice Telephone | 2077734651 |
| Practice Fax Number | 2077738940 |
| Mailing Telephone | 2077734651 |
| Mailing Fax Number | 2077738940 |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2014-02-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | CR2084 | ME | Chiropractic Providers |
| N | 111N00000X | Chiropractor | 06446 | IA | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 0463422 | 05 | |
| IA | WELLMARK NUMBER | 39100 | 01 |
| Street Address |
611 BRIGHTON AVE |
| City | PORTLAND |
| State | ME |
| Zip Code | 04102-2322 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558431080 | Jason Kassir | Dentist | 611 Brighton Ave, Portland, ME 04102-2322 | 2006-11-09 |
| 1528157062 | Raymond Chiropractic Pa | Chiropractor | 611 Brighton Ave, Portland, ME 04102-2322 | 2006-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720602964 | Ci Yen Joanna Man | Student in an Organized Health Care Education/Training Program | 190 Park Ave., Portland, ME 04102 | 2020-06-03 |
| 1841811338 | Abby Zarotny Sahagian | Nurse Anesthetist, Certified Registered | Mmc Anesthesia and Perioperative Medicine, 22 Bramhall St, Portland, ME 04102 | 2020-05-06 |
| 1124656863 | Zachary Bernard Tillett | Student in an Organized Health Care Education/Training Program | Maine Medical Center 22 Bramhall St., Portland, ME 04102 | 2020-03-30 |
| 1215564323 | Joshua Allen Swenson | Student in an Organized Health Care Education/Training Program | 33 Bramhall St, Portland, ME 04102 | 2020-03-26 |
| 1740776434 | Rishi Phakey | Dentist | Community Dental, 190 Park Ave, Portland, ME 04102 | 2018-07-05 |
| 1982192571 | Jessica Thomas | Doula | 619 Brighton Ave #101, Rosemont Wellness Center, Portland, ME 04102 | 2018-04-29 |
| 1699270744 | Shane D Kirkegaard | Student in an Organized Health Care Education/Training Program | Maine Medical Center 22 Bramhall Street, Portland, ME 04102 | 2018-03-29 |
| 1144752494 | Al-shawk Home Healthcare, LLC | Technician | 640 Brighton Ave Ste 8, Portland, ME 04102 | 2017-03-28 |
| 1376074674 | Samuel B Potter | Emergency Medicine | Maine Medical Center, 22 Bramhall Street, Portland, ME 04102 | 2017-03-27 |
| 1043767536 | Kevin De Ruiter | Social Worker | 129 Pine St Apt 6, Portland, ME 04102 | 2016-09-01 |
| Find all providers in zip 04102 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700486958 | Amy Elizabeth Goebel | Chiropractor | 5103 Se Stark St Apt B, Portland, OR 97215-1764 | 2020-10-27 |
| 1003423914 | Evergreen Chiropractic PC | Chiropractor | 7145 Sw Varns St Ste 203, Portland, OR 97223-8168 | 2020-09-24 |
| 1750993283 | University of Western States Healthcare Inc | Chiropractor | 8000 Ne Tillamook St, Portland, OR 97213-6655 | 2020-08-17 |
| 1518587989 | Kristy Pearl Arneson | Chiropractor | 3715 Se Cesar E Chavez Blvd, Portland, OR 97202-1704 | 2020-04-25 |
| 1770102956 | Behireta Corbadzic | Chiropractor | 12923 Se Foster Rd Unit G703, Portland, OR 97236-4702 | 2020-04-08 |
| 1134754427 | Bonnie Anderson | Chiropractor | 3539 N Williams Ave Ste 202a, Portland, OR 97227-1437 | 2020-03-06 |
| 1629601372 | Megan Adele Robles | Chiropractor | 2100 Ne Broadway St Ste 255, Portland, OR 97232-1544 | 2020-02-20 |
| 1306479472 | Naomi M Enos-burles | Chiropractor | 7332 Sw 13th Dr Apt A, Portland, OR 97219-2089 | 2020-02-18 |
| 1184256927 | Michael Nicosia | Chiropractor | 207 Santa Monica St, Portland, TX 78374-2645 | 2020-02-10 |
| 1942832258 | Tracy Yvonne Still | Chiropractor | 3905b Ne Grand Ave Unit B, Portland, OR 97212-1107 | 2020-02-05 |
| Find all providers in PORTLAND | ||||
Please comment or provide details below to improve the information on DR. KYLE STANLEY DEDEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.