Provider Demographics
NPI:1073805115
Name:PERKINS, TYLER J (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:J
Last Name:PERKINS
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 1:117 S SUNSET ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6180
Mailing Address - Country:US
Mailing Address - Phone:303-651-1810
Mailing Address - Fax:
Practice Address - Street 1:117 S SUNSET ST
Practice Address - Street 2:SUITE H
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6180
Practice Address - Country:US
Practice Address - Phone:303-651-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6680111N00000X
NE1741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor