Provider Demographics
NPI:1891065702
Name:HASSE, TYLER J (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:J
Last Name:HASSE
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 1:2350 RIDGE DR APT 109
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4345 NATHAN LN N
Practice Address - Street 2:SUITE F
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-4522
Practice Address - Country:US
Practice Address - Phone:763-536-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor