Provider Demographics
NPI:1306492244
Name:MUNN, TYLER R (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:R
Last Name:MUNN
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 1:300 S LEXINGTON SPRINGMILL RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1398
Mailing Address - Country:US
Mailing Address - Phone:419-529-2703
Mailing Address - Fax:
Practice Address - Street 1:300 S LEXINGTON SPRINGMILL RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1398
Practice Address - Country:US
Practice Address - Phone:419-529-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor