Provider Demographics
NPI:1083129514
Name:RIESGRAF, TYLER (DC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:RIESGRAF
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 1:14413 EXCELSIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-5821
Mailing Address - Country:US
Mailing Address - Phone:952-746-1506
Mailing Address - Fax:952-746-1508
Practice Address - Street 1:14413 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-5821
Practice Address - Country:US
Practice Address - Phone:952-746-1506
Practice Address - Fax:952-746-1508
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor