Provider Demographics
NPI:1811537129
Name:AWE, TYLER LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:LEE
Last Name:AWE
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 1:3155 N COLLEGE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3500
Mailing Address - Country:US
Mailing Address - Phone:479-366-2524
Mailing Address - Fax:
Practice Address - Street 1:3155 N COLLEGE AVE STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3500
Practice Address - Country:US
Practice Address - Phone:479-366-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor