Provider Demographics
NPI:1437539657
Name:PETERNELL, TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:PETERNELL
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 1:24 3RD AVE S
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-4544
Mailing Address - Country:US
Mailing Address - Phone:320-686-0137
Mailing Address - Fax:
Practice Address - Street 1:24 3RD AVE S
Practice Address - Street 2:SUITE 4
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-4544
Practice Address - Country:US
Practice Address - Phone:320-686-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor