Healthcare Provider Details

I. General information

NPI: 1629984737
Provider Name (Legal Business Name): DANIEL TYLER ACA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 E ALAMEDA RD
POCATELLO ID
83201-3659
US

IV. Provider business mailing address

703 E ALAMEDA RD
POCATELLO ID
83201-3659
US

V. Phone/Fax

Practice location:
  • Phone: 208-237-5322
  • Fax: 208-478-1455
Mailing address:
  • Phone: 208-237-5322
  • Fax: 208-478-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA-1838
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: