Provider Demographics
NPI:1083256333
Name:DUTT, TYLER SETH (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:SETH
Last Name:DUTT
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 1:7125 MARVIN D LOVE FWY STE 107
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3111
Mailing Address - Country:US
Mailing Address - Phone:972-332-5029
Mailing Address - Fax:
Practice Address - Street 1:7125 MARVIN D LOVE FWY STE 107
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3111
Practice Address - Country:US
Practice Address - Phone:972-332-5029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor