Healthcare Provider Details

I. General information

NPI: 1003340225
Provider Name (Legal Business Name): DR. TYLER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 BRISTOL ST STE 160
COSTA MESA CA
92626-3077
US

IV. Provider business mailing address

3070 BRISTOL ST STE 160
COSTA MESA CA
92626-3077
US

V. Phone/Fax

Practice location:
  • Phone: 949-662-1616
  • Fax: 714-486-2834
Mailing address:
  • Phone: 949-662-1616
  • Fax: 714-486-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number30491
License Number StateCA

VIII. Authorized Official

Name: DR. TYLER HOUSTON
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 714-315-5731