Provider Demographics
NPI:1043772346
Name:PENSIS, TYLER
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:PENSIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4791 CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-6102
Mailing Address - Country:US
Mailing Address - Phone:715-304-9645
Mailing Address - Fax:
Practice Address - Street 1:W5675 CTY HWY B
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166
Practice Address - Country:US
Practice Address - Phone:715-526-6158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5446-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5446-12OtherSTATE LICENSE NUMBER