Healthcare Provider Details

I. General information

NPI: 1275888380
Provider Name (Legal Business Name): SETH TYSON OQUIST D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 YALE PL
CANON CITY CO
81212-4611
US

IV. Provider business mailing address

612 YALE PL
CANON CITY CO
81212-4611
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-0100
  • Fax: 719-275-0110
Mailing address:
  • Phone: 719-275-0100
  • Fax: 719-275-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR009014
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6815
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: