Provider Demographics
NPI:1356697791
Name:JORGENSEN, TYLER (DC, BS)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:JORGENSEN
Suffix:
Gender:M
Credentials:DC, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S BAILEY ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6991
Mailing Address - Country:US
Mailing Address - Phone:907-707-1380
Mailing Address - Fax:
Practice Address - Street 1:808 S BAILEY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6991
Practice Address - Country:US
Practice Address - Phone:907-707-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor