Healthcare Provider Details

I. General information

NPI: 1316888456
Provider Name (Legal Business Name): TYLER PROCTOR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11728 S 3600 W
SOUTH JORDAN UT
84095-5931
US

IV. Provider business mailing address

2826 S 2475 E
SALT LAKE CITY UT
84109-1828
US

V. Phone/Fax

Practice location:
  • Phone: 801-871-0712
  • Fax:
Mailing address:
  • Phone: 801-520-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11641006-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: