Provider Demographics
NPI:1154620037
Name:PAGE, TYLER CURTIS (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:CURTIS
Last Name:PAGE
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 1:12 COOGAN BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1938
Mailing Address - Country:US
Mailing Address - Phone:860-245-4620
Mailing Address - Fax:860-245-5752
Practice Address - Street 1:12 COOGAN BLVD STE 204
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1938
Practice Address - Country:US
Practice Address - Phone:860-245-4620
Practice Address - Fax:860-245-5752
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001879111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0100045708OtherMEDICARE PTAN