Healthcare Provider Details

I. General information

NPI: 1174335343
Provider Name (Legal Business Name): TYLER-BROOKS ARVISO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E NIZHONI BLVD
GALLUP NM
87301-5744
US

IV. Provider business mailing address

1504 DIAMOND CIR
GALLUP NM
87301-4900
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-7575
  • Fax:
Mailing address:
  • Phone: 505-879-2449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-2025-0002
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: