Healthcare Provider Details

I. General information

NPI: 1245048156
Provider Name (Legal Business Name): TYRELL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 CAPITOL ST NE
SALEM OR
97301-1201
US

IV. Provider business mailing address

910 CAPITOL ST NE
SALEM OR
97301-1201
US

V. Phone/Fax

Practice location:
  • Phone: 503-851-5518
  • Fax:
Mailing address:
  • Phone: 503-851-5518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRYCE LISSER
Title or Position: DIRECTOR
Credential: LAC
Phone: 503-830-8880