Provider Demographics
NPI:1245899814
Name:PEPE, TYLER JASON (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JASON
Last Name:PEPE
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 1:3670 S BENZING RD STE L
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1741
Mailing Address - Country:US
Mailing Address - Phone:716-667-2653
Mailing Address - Fax:716-219-1072
Practice Address - Street 1:3670 S BENZING RD STE L
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1741
Practice Address - Country:US
Practice Address - Phone:716-667-2653
Practice Address - Fax:716-219-1072
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX013255-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty