Provider Demographics
NPI:1225094089
Name:EARNST, WILLIAM TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TYLER
Last Name:EARNST
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 1:231 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-2113
Mailing Address - Country:US
Mailing Address - Phone:336-434-4600
Mailing Address - Fax:336-434-4610
Practice Address - Street 1:231 BAKER RD
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-2113
Practice Address - Country:US
Practice Address - Phone:336-434-4600
Practice Address - Fax:336-434-4610
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890835JMedicaid
NC0835JOtherBCBSNC PROVIDER #
NCU74855Medicare UPIN
NC890835JMedicaid