Provider Demographics
NPI:1710121082
Name:PEREZ, TYSON MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:TYSON
Middle Name:MICHAEL
Last Name:PEREZ
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 1:3144 EL CAMINO REAL
Mailing Address - Street 2:#201
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2194
Mailing Address - Country:US
Mailing Address - Phone:760-720-2920
Mailing Address - Fax:760-720-2930
Practice Address - Street 1:3144 EL CAMINO REAL
Practice Address - Street 2:#201
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2194
Practice Address - Country:US
Practice Address - Phone:760-720-2920
Practice Address - Fax:760-720-2930
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor