Provider Demographics
NPI:1295349215
Name:VERETTO, TYLER (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:VERETTO
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 1:158 SULLIVAN AVENUE
Mailing Address - Street 2:UNIT 5
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1878
Mailing Address - Country:US
Mailing Address - Phone:860-986-4118
Mailing Address - Fax:
Practice Address - Street 1:158 SULLIVAN AVENUE
Practice Address - Street 2:UNIT 5
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074
Practice Address - Country:US
Practice Address - Phone:860-986-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor