Provider Demographics
NPI:1083064588
Name:TYER, KENNEDY KENNETH (DC)
Entity Type:Individual
Prefix:
First Name:KENNEDY
Middle Name:KENNETH
Last Name:TYER
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 1:2022 W ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-2708
Mailing Address - Country:US
Mailing Address - Phone:713-522-9814
Mailing Address - Fax:713-522-3047
Practice Address - Street 1:2022 W ALABAMA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-2708
Practice Address - Country:US
Practice Address - Phone:713-522-9814
Practice Address - Fax:713-522-3047
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX513711ZZC7Medicare PIN
TX513711ZH7TMedicare PIN