Provider Demographics
NPI:1629290705
Name:BRATVOLD, TYREN J (DC)
Entity Type:Individual
Prefix:DR
First Name:TYREN
Middle Name:J
Last Name:BRATVOLD
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 1:628 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3208
Mailing Address - Country:US
Mailing Address - Phone:253-845-6636
Mailing Address - Fax:253-770-1152
Practice Address - Street 1:628 3RD ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3208
Practice Address - Country:US
Practice Address - Phone:253-845-6636
Practice Address - Fax:253-770-1152
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003571111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026490Medicaid
WA2026490Medicaid
WA473894Medicare UPIN