Provider Demographics
NPI:1336765015
Name:HOELTING, TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:HOELTING
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 1:3536 JERSEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2223
Mailing Address - Country:US
Mailing Address - Phone:563-940-4843
Mailing Address - Fax:
Practice Address - Street 1:3536 JERSEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2223
Practice Address - Country:US
Practice Address - Phone:563-940-4843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020012516111N00000X
IA123217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1336765015Medicaid
MO2020012516Medicaid