Healthcare Provider Details

I. General information

NPI: 1881052884
Provider Name (Legal Business Name): TYLER HOVE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 RAMSAY WAY STE 113
KENT WA
98032
US

IV. Provider business mailing address

417 RAMSAY WAY STE 113
KENT WA
98032-4502
US

V. Phone/Fax

Practice location:
  • Phone: 253-859-0100
  • Fax: 253-373-9600
Mailing address:
  • Phone: 253-859-0100
  • Fax: 253-373-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: