Healthcare Provider Details

I. General information

NPI: 1043072176
Provider Name (Legal Business Name): KYLE SCOTT TANZER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N TOWN EAST BLVD STE 135
MESQUITE TX
75150-4109
US

IV. Provider business mailing address

1515 N TOWN EAST BLVD STE 135
MESQUITE TX
75150-4109
US

V. Phone/Fax

Practice location:
  • Phone: 972-279-7246
  • Fax:
Mailing address:
  • Phone: 972-279-7246
  • Fax: 999-999-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16528
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: