Healthcare Provider Details

I. General information

NPI: 1558713719
Provider Name (Legal Business Name): TYLER MUSGRAVE DC, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6132 HAVELOCK AVE APT 1
LINCOLN NE
68507-1225
US

IV. Provider business mailing address

6132 HAVELOCK AVE APT 1
LINCOLN NE
68507-1225
US

V. Phone/Fax

Practice location:
  • Phone: 402-705-5019
  • Fax:
Mailing address:
  • Phone: 402-705-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2210
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: