Provider Demographics
NPI:1972010569
Name:NENABER, TYLER B (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:B
Last Name:NENABER
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 1:2500 W 46TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6507
Mailing Address - Country:US
Mailing Address - Phone:605-335-3008
Mailing Address - Fax:
Practice Address - Street 1:2500 W 46TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SC
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-335-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1324OtherBCBS, DAKOTACARE, UHS, AVERA, SANFORD