Healthcare Provider Details

I. General information

NPI: 1376544692
Provider Name (Legal Business Name): DON TYLER HANDLY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/03/2021
Certification Date: 10/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 KINGS MOUNTAIN RD
COLLINSVILLE VA
24078-1828
US

IV. Provider business mailing address

4848 KINGS MOUNTAIN RD
COLLINSVILLE VA
24078-1275
US

V. Phone/Fax

Practice location:
  • Phone: 276-647-3728
  • Fax: 276-622-2003
Mailing address:
  • Phone: 276-647-3728
  • Fax: 276-622-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001795
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: