Provider Demographics
NPI:1790802551
Name:STROEBEL, TYLER (LAC)
Entity Type:Individual
Prefix:MRS
First Name:TYLER
Middle Name:
Last Name:STROEBEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 38TH ST STE 205W
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2637
Mailing Address - Country:US
Mailing Address - Phone:720-201-3817
Mailing Address - Fax:
Practice Address - Street 1:1650 38TH ST STE 205W
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2637
Practice Address - Country:US
Practice Address - Phone:720-201-3817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO873171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist