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NPI Code Detail

MEDICARE: TYLER DEROSIA DC, ATC

MEDICARE: TYLER DEROSIA DC, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor038013850IL

General Provider Information

NPI Number : 1053850032
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER DEROSIA DC, ATC
Provider Business Mailing Address
First Line : 11001 S KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2221
Country : US
Telephone Number : 737-293-7777
Fax Number :
Provider Business Practice Location Address
First Line : 11001 S KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2221
Country : US
Telephone Number : 773-239-7777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2017
Last Update Date : 10/02/2024

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Directions to “ TYLER DEROSIA DC, ATC” Practice Location

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