Provider Demographics
NPI:1639449846
Name:EVANS, TYLER ALEXANDER (DC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:ALEXANDER
Last Name:EVANS
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 1:13128 TOTEM LAKE BLVD NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2953
Mailing Address - Country:US
Mailing Address - Phone:425-820-8837
Mailing Address - Fax:425-820-7009
Practice Address - Street 1:13128 TOTEM LAKE BLVD NE
Practice Address - Street 2:SUITE 203
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2953
Practice Address - Country:US
Practice Address - Phone:425-820-8837
Practice Address - Fax:425-820-7009
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60264414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor