Provider Demographics
NPI:1265593826
Name:TYLER, LAWRENCE P (DC)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:P
Last Name:TYLER
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 1:305 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-2322
Mailing Address - Country:US
Mailing Address - Phone:636-239-2323
Mailing Address - Fax:636-239-7168
Practice Address - Street 1:305 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-2322
Practice Address - Country:US
Practice Address - Phone:636-239-2323
Practice Address - Fax:636-239-7168
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor