MEDICARE: DR. DON TYLER HANDLY D.C.

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	0104001795	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	265389	OTHER		BLUE CROSS/BLUE SHIELD
2	265389	OTHER	VA	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1376544692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DON TYLER HANDLY D.C.

Provider Business Mailing Address
First Line	:	4848 KINGS MOUNTAIN RD
Second Line	:
City	:	COLLINSVILLE
State	:	VA
Zip	:	24078-1275
Country	:	US
Telephone Number	:	276-647-3728
Fax Number	:	276-622-2003

Provider Business Practice Location Address
First Line	:	4848 KINGS MOUNTAIN RD
Second Line	:
City	:	COLLINSVILLE
State	:	VA
Zip	:	24078-1828
Country	:	US
Telephone Number	:	276-647-3728
Fax Number	:	276-622-2003

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	10/03/2021

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