Provider Demographics
NPI:1134482227
Name:SCHREPEL, TYSON ADLAI (LAC, CBP)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:ADLAI
Last Name:SCHREPEL
Suffix:
Gender:M
Credentials:LAC, CBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12583 W 2ND DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-5014
Mailing Address - Country:US
Mailing Address - Phone:303-807-1377
Mailing Address - Fax:
Practice Address - Street 1:390 UNION BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1510
Practice Address - Country:US
Practice Address - Phone:303-807-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1783171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist