Provider Demographics
NPI:1598171571
Name:ARVIDSON, TYGUE ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:TYGUE
Middle Name:ANDREW
Last Name:ARVIDSON
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 1:5302 YACHT HAVEN GRANDE
Mailing Address - Street 2:UNIT 49
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-5004
Mailing Address - Country:US
Mailing Address - Phone:340-998-7357
Mailing Address - Fax:
Practice Address - Street 1:5302 YACHT HAVEN GRANDE
Practice Address - Street 2:SUITE 100
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-5004
Practice Address - Country:US
Practice Address - Phone:340-998-7357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010181111N00000X
VI68111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIIL573AMedicare PIN