Provider Demographics
NPI:1750857116
Name:COLLINS, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N HYATT ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-4022
Mailing Address - Country:US
Mailing Address - Phone:870-367-1919
Mailing Address - Fax:870-367-2807
Practice Address - Street 1:106 N HYATT ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4022
Practice Address - Country:US
Practice Address - Phone:870-367-1919
Practice Address - Fax:870-367-2807
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ART16207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor