Provider Demographics
NPI:1164183687
Name:BAKER, TYLER GREGORY
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:GREGORY
Last Name:BAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5069 W 13400 S STE 100
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6603
Mailing Address - Country:US
Mailing Address - Phone:801-253-8141
Mailing Address - Fax:
Practice Address - Street 1:5069 W 13400 S STE 100
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-6603
Practice Address - Country:US
Practice Address - Phone:801-253-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12600904-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT12600904-1202OtherDOPL OF UTAH