Provider Demographics
NPI:1154853521
Name:OKERLUND, TYLER JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JAMES
Last Name:OKERLUND
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:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-0042
Mailing Address - Country:US
Mailing Address - Phone:952-442-2409
Mailing Address - Fax:
Practice Address - Street 1:1750 TOWER BLVD
Practice Address - Street 2:SUITE #203
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-4566
Practice Address - Country:US
Practice Address - Phone:952-442-2409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor