Provider Demographics
NPI:1427347830
Name:TYLER, WYATT WESLEY (DC)
Entity type:Individual
Prefix:DR
First Name:WYATT
Middle Name:WESLEY
Last Name:TYLER
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 1:8515 DOUGLAS AVE
Mailing Address - Street 2:STE. 25
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2915
Mailing Address - Country:US
Mailing Address - Phone:515-278-2225
Mailing Address - Fax:
Practice Address - Street 1:8515 DOUGLAS AVE
Practice Address - Street 2:STE. 25
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2915
Practice Address - Country:US
Practice Address - Phone:515-278-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1427347830Medicaid
IA1427347830Medicaid
IA1427347830Medicare PIN