Provider Demographics
NPI:1346384427
Name:TYNER, JOHN E (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:TYNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:TYNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1308
Mailing Address - Street 2:302 W ANDERSON ST
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541-1308
Mailing Address - Country:US
Mailing Address - Phone:360-482-5110
Mailing Address - Fax:
Practice Address - Street 1:302 W ANDERSON ST
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541-1308
Practice Address - Country:US
Practice Address - Phone:360-482-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA13128OtherDEPARTMENT OF LABOR & IND
WATY0034OtherREGENCE BLUE SHIELD