Provider Demographics
NPI:1659732832
Name:RICKELMAN, TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:RICKELMAN
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 1:105 N 36TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3704
Mailing Address - Country:US
Mailing Address - Phone:217-214-2692
Mailing Address - Fax:217-214-2035
Practice Address - Street 1:105 N 36TH ST STE 101
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3704
Practice Address - Country:US
Practice Address - Phone:217-214-2692
Practice Address - Fax:217-214-2035
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor