Provider Demographics
NPI:1336789924
Name:GAINES, TYLER A (DC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:A
Last Name:GAINES
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 1:3 OAKWOOD PARK PLZ STE 103
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1888
Mailing Address - Country:US
Mailing Address - Phone:405-625-6786
Mailing Address - Fax:
Practice Address - Street 1:3 OAKWOOD PARK PLZ STE 103
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1888
Practice Address - Country:US
Practice Address - Phone:405-625-6786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008143111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty