Healthcare Provider Details

I. General information

NPI: 1598389249
Provider Name (Legal Business Name): TYLER ALAN PLOSS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1873 E SYCAMORE ST
KOKOMO IN
46901-5200
US

IV. Provider business mailing address

19449 ETHAN ALLEN LN
WESTFIELD IN
46074-9252
US

V. Phone/Fax

Practice location:
  • Phone: 765-450-9153
  • Fax:
Mailing address:
  • Phone: 765-419-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08003326A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2020014160
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: