Provider Demographics
NPI:1376544692
Name:HANDLY, DON TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:TYLER
Last Name:HANDLY
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 1:4848 KINGS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24078-1275
Mailing Address - Country:US
Mailing Address - Phone:276-647-3728
Mailing Address - Fax:276-622-2003
Practice Address - Street 1:4848 KINGS MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24078-1828
Practice Address - Country:US
Practice Address - Phone:276-647-3728
Practice Address - Fax:276-622-2003
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
265389OtherBLUE CROSS/BLUE SHIELD
VA265389OtherBLUE CROSS/BLUE SHIELD