MEDICARE: TYLER B WILT D.C., P.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	DC011093	PA

General Provider Information

NPI Number	:	1437514833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYLER B WILT D.C., P.C.

Provider Business Mailing Address
First Line	:	333 BROAD ST
Second Line	:
City	:	MONTOURSVILLE
State	:	PA
Zip	:	17754-2205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 BROAD ST
Second Line	:
City	:	MONTOURSVILLE
State	:	PA
Zip	:	17754-2205
Country	:	US
Telephone Number	:	570-368-2897
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TYLER B WILT
Credential	:	D.C.
Telephone Number	:	570-765-0965

Provider Enumeration Date	:	12/29/2015
Last Update Date	:	12/29/2015

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