Healthcare Provider Details

I. General information

NPI: 1285640029
Provider Name (Legal Business Name): TYLER GEORGE TINCKNELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S LINCOLNWAY SUITE C
NORTH AURORA IL
60542-1663
US

IV. Provider business mailing address

106 S LINCOLNWAY SUITE C
NORTH AURORA IL
60542-1663
US

V. Phone/Fax

Practice location:
  • Phone: 630-897-9300
  • Fax: 630-897-0727
Mailing address:
  • Phone: 630-897-9300
  • Fax: 630-897-0727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: