Provider Demographics
NPI:1851957237
Name:SIMPSON, TYLER WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:WILLIAM
Last Name:SIMPSON
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 1:5324 E SHOSHONE AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-3266
Mailing Address - Country:US
Mailing Address - Phone:760-505-6166
Mailing Address - Fax:
Practice Address - Street 1:2900 BRISTOL ST STE C105
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5944
Practice Address - Country:US
Practice Address - Phone:760-505-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-11
Last Update Date:2019-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor