Provider Demographics
NPI:1275904989
Name:TYSON CHIROPRACTIC AUTO INJURY AND REHAB CENTER, INC
Entity Type:Organization
Organization Name:TYSON CHIROPRACTIC AUTO INJURY AND REHAB CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-443-5223
Mailing Address - Street 1:11974 BALM RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-6601
Mailing Address - Country:US
Mailing Address - Phone:813-443-5223
Mailing Address - Fax:813-443-5699
Practice Address - Street 1:11974 BALM RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-6601
Practice Address - Country:US
Practice Address - Phone:813-443-5223
Practice Address - Fax:813-443-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty