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General NPI Number Information
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NPI Number | 1801133129
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Entity Type | Individual
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Provider Name | TYLER JOHN EMMERT D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 4050 FAIRVIEW INDUSTRIAL DR SE STE 100
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City | SALEM
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State | OR
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Zip | 97302-1006
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Country | US
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Telephone | 541-359-7770
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Fax | 503-388-7629
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Provider Business Mailing Address
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Address Line | 2504 SHIPMAN LN SE
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City | SALEM
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State | OR
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Zip | 97317-9236
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Country | US
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Telephone | 541-359-7770
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Fax | 503-388-7629
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5111
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License Number State | OR
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