Provider Demographics
NPI:1609148253
Name:SMITH, TYLER DANIEL (MS, DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:DANIEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 WINNE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2646 WINNE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4915
Practice Address - Country:US
Practice Address - Phone:406-579-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-29
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-1820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011001874Medicare PIN