MEDICARE: DR. TYLER JOHN EMMERT 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	5111	OR

General Provider Information

NPI Number	:	1801133129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER JOHN EMMERT D.C.

Provider Business Mailing Address
First Line	:	2504 SHIPMAN LN SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97317-9236
Country	:	US
Telephone Number	:	541-359-7770
Fax Number	:	503-388-7629

Provider Business Practice Location Address
First Line	:	4050 FAIRVIEW INDUSTRIAL DR SE STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-1006
Country	:	US
Telephone Number	:	541-359-7770
Fax Number	:	503-388-7629

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

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	06/08/2022

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