Provider Demographics
NPI:1275045601
Name:STEWART, TYLER JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JAMES
Last Name:STEWART
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 1:2300 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3010
Mailing Address - Country:US
Mailing Address - Phone:313-565-4500
Mailing Address - Fax:
Practice Address - Street 1:2300 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3010
Practice Address - Country:US
Practice Address - Phone:313-565-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04764111N00000X
MI2301010571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor