Provider Demographics
NPI:1588288583
Name:TORKELSON, TYLER (DC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:TORKELSON
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 1:515 S RESERVE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2125
Mailing Address - Country:US
Mailing Address - Phone:715-896-2710
Mailing Address - Fax:
Practice Address - Street 1:515 S RESERVE ST STE 3
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2125
Practice Address - Country:US
Practice Address - Phone:715-896-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-6158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor