Provider Demographics
NPI:1285640029
Name:TINCKNELL, TYLER GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:GEORGE
Last Name:TINCKNELL
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 1:106 S LINCOLNWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1663
Mailing Address - Country:US
Mailing Address - Phone:630-897-9300
Mailing Address - Fax:630-897-0727
Practice Address - Street 1:106 S LINCOLNWAY
Practice Address - Street 2:SUITE C
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1663
Practice Address - Country:US
Practice Address - Phone:630-897-9300
Practice Address - Fax:630-897-0727
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201773Medicare ID - Type Unspecified
ILU90131Medicare UPIN