Provider Demographics
NPI:1487145934
Name:GAGON, TYLER G (DC, AC)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:G
Last Name:GAGON
Suffix:
Gender:M
Credentials:DC, AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3088 N ROBERT RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8653
Mailing Address - Country:US
Mailing Address - Phone:928-775-0522
Mailing Address - Fax:928-775-5922
Practice Address - Street 1:3088 N ROBERT RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8653
Practice Address - Country:US
Practice Address - Phone:928-775-0522
Practice Address - Fax:928-775-5922
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108041421202111N00000X
AZ0631171100000X
AZ9341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist