Provider Demographics
NPI:1629782065
Name:STROMBERG, TYSON (DC)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:
Last Name:STROMBERG
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 1:3384 W 4600 S STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-9222
Mailing Address - Country:US
Mailing Address - Phone:801-731-9899
Mailing Address - Fax:
Practice Address - Street 1:3384 W 4600 S STE 1
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-9222
Practice Address - Country:US
Practice Address - Phone:801-731-9899
Practice Address - Fax:801-731-9897
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13160337-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor