MEDICARE: DR. DARRIN PHILLIP TYSON DC

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	CH8966	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AJ095	OTHER	FL	PTAN
2	22086	OTHER	FL	BLUE CROSS BLUE SHEILDS

General Provider Information

NPI Number	:	1851499909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRIN PHILLIP TYSON DC

Provider Business Mailing Address
First Line	:	920 W, LUMSDEN RD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-6281
Country	:	US
Telephone Number	:	813-413-8465
Fax Number	:	813-413-8466

Provider Business Practice Location Address
First Line	:	11974 BALM RIVERVIEW RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-6601
Country	:	US
Telephone Number	:	813-443-5223
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/27/2019

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