MEDICARE: TYLER ALLEN MALUEG

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
1	111N00000X	Chiropractor	5287-12	WI

General Provider Information

NPI Number	:	1376067413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER ALLEN MALUEG

Provider Business Mailing Address
First Line	:	2069 CENTRAL CT STE 11
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-4281
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2069 CENTRAL CT STE 11
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-4281
Country	:	US
Telephone Number	:	920-241-6808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2017
Last Update Date	:	07/31/2017

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Directions to “ TYLER ALLEN MALUEG ” Practice Location

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