Provider Demographics
NPI:1174827224
Name:IDEUS, TYLER MARK (DC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:MARK
Last Name:IDEUS
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 1:9100 ANDERMATT DR STE 2
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-6700
Mailing Address - Country:US
Mailing Address - Phone:402-239-2298
Mailing Address - Fax:
Practice Address - Street 1:9100 ANDERMATT DR STE 2
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-6700
Practice Address - Country:US
Practice Address - Phone:402-239-2298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor