Healthcare Provider Details

I. General information

NPI: 1407948169
Provider Name (Legal Business Name): TYLER S HURST D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 OAKLEY AVE
BURLEY ID
83318-1840
US

IV. Provider business mailing address

1246 OAKLEY AVE
BURLEY ID
83318-1840
US

V. Phone/Fax

Practice location:
  • Phone: 208-678-8184
  • Fax: 208-678-8164
Mailing address:
  • Phone: 208-678-8184
  • Fax: 208-678-8164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-1213
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: