Provider Demographics
NPI:1346461498
Name:TYER, KENNETH KARL JR
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:KARL
Last Name:TYER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 WINDY GORGE DR.
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345
Mailing Address - Country:US
Mailing Address - Phone:713-398-6199
Mailing Address - Fax:
Practice Address - Street 1:5912 SPENCER HIGHWAY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-1699
Practice Address - Country:US
Practice Address - Phone:281-487-1501
Practice Address - Fax:281-487-0581
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4616111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601833Medicare ID - Type Unspecified