Provider Demographics
NPI:1487021234
Name:BURKE, TYLER JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JOSEPH
Last Name:BURKE
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 1:16548 NE HALSEY ST APT 113
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-8612
Mailing Address - Country:US
Mailing Address - Phone:208-340-1573
Mailing Address - Fax:
Practice Address - Street 1:2456 E POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1311
Practice Address - Country:US
Practice Address - Phone:503-298-9986
Practice Address - Fax:503-914-1496
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2020-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5657111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician