Provider Demographics
NPI:1063624856
Name:TREXLER, TYRONE THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:TYRONE
Middle Name:THOMAS
Last Name:TREXLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:COULEE CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99115-0817
Mailing Address - Country:US
Mailing Address - Phone:509-632-8668
Mailing Address - Fax:509-632-5761
Practice Address - Street 1:130 N ADAMS
Practice Address - Street 2:
Practice Address - City:COULEE CITY
Practice Address - State:WA
Practice Address - Zip Code:99115
Practice Address - Country:US
Practice Address - Phone:509-632-8668
Practice Address - Fax:509-632-5761
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0202642OtherLABOR & INDUST #
WAP00260911Medicare ID - Type UnspecifiedRAILROAD MEDICARE #
WA0202642OtherLABOR & INDUST #