Provider Demographics
NPI:1396001145
Name:POTTENGER, TYSON (DC, BCAO)
Entity Type:Individual
Prefix:DR
First Name:TYSON
Middle Name:
Last Name:POTTENGER
Suffix:
Gender:M
Credentials:DC, BCAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 CREEK BEND CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-8088
Mailing Address - Country:US
Mailing Address - Phone:740-525-9967
Mailing Address - Fax:
Practice Address - Street 1:112 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1129
Practice Address - Country:US
Practice Address - Phone:740-291-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor