MEDICARE: TYLER WHITTAKER 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	6017229-1202	UT

General Provider Information

NPI Number	:	1831216811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER WHITTAKER D.C.

Provider Business Mailing Address
First Line	:	436 S 225 W
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-3230
Country	:	US
Telephone Number	:	435-865-7609
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 N MAIN ST
Second Line	:	SUITE 205
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-7744
Country	:	US
Telephone Number	:	435-586-7575
Fax Number	:	435-586-7575

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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