Provider Demographics
NPI:1184731374
Name:ROSS, MICHAEL TYLER (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TYLER
Last Name:ROSS
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 1:722 BARING BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-1500
Mailing Address - Country:US
Mailing Address - Phone:775-359-1009
Mailing Address - Fax:775-359-2925
Practice Address - Street 1:1281 BARING BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8673
Practice Address - Country:US
Practice Address - Phone:775-359-1009
Practice Address - Fax:775-359-2925
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVCB509ZMedicare PIN