Provider Demographics
NPI:1598389249
Name:PLOSS, TYLER ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ALAN
Last Name:PLOSS
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 1:19449 ETHAN ALLEN LN
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9252
Mailing Address - Country:US
Mailing Address - Phone:765-419-1101
Mailing Address - Fax:
Practice Address - Street 1:1873 E SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-5200
Practice Address - Country:US
Practice Address - Phone:765-450-9153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003326A111N00000X
MO2020014160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN08003326AOtherINDIANA CHIROPRACTIC LICENSE