Healthcare Provider Details

I. General information

NPI: 1225094089
Provider Name (Legal Business Name): WILLIAM TYLER EARNST D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 BAKER RD
ARCHDALE NC
27263-2113
US

IV. Provider business mailing address

231 BAKER RD
ARCHDALE NC
27263-2113
US

V. Phone/Fax

Practice location:
  • Phone: 336-434-4600
  • Fax: 336-434-4610
Mailing address:
  • Phone: 336-434-4600
  • Fax: 336-434-4610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2600
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: