Provider Demographics
NPI:1891440111
Name:FAUST, TYLER MATHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:MATHEW
Last Name:FAUST
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:PO BOX 975
Mailing Address - Street 2:
Mailing Address - City:CLARKDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:86324-0975
Mailing Address - Country:US
Mailing Address - Phone:928-800-4345
Mailing Address - Fax:
Practice Address - Street 1:747 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3644
Practice Address - Country:US
Practice Address - Phone:928-800-4345
Practice Address - Fax:928-832-4345
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor