Provider Demographics
NPI:1184635641
Name:ALLISON, TYLER JAMES (DC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:ALLISON
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 175
Mailing Address - Street 2:
Mailing Address - City:GOLD BAR
Mailing Address - State:WA
Mailing Address - Zip Code:98251-0175
Mailing Address - Country:US
Mailing Address - Phone:360-793-0904
Mailing Address - Fax:360-799-0923
Practice Address - Street 1:301 CROFT AVE
Practice Address - Street 2:
Practice Address - City:GOLD BAR
Practice Address - State:WA
Practice Address - Zip Code:98251
Practice Address - Country:US
Practice Address - Phone:360-793-0904
Practice Address - Fax:360-799-0923
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA167260OtherDEPT. OF L&I
WA4234ALOtherREGENCE BLUE SHIELD
WA167260OtherDEPT. OF L&I
WA4234ALOtherREGENCE BLUE SHIELD