Provider Demographics
NPI:1801133129
Name:EMMERT, TYLER JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JOHN
Last Name:EMMERT
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 1:2504 SHIPMAN LN SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-9236
Mailing Address - Country:US
Mailing Address - Phone:541-359-7770
Mailing Address - Fax:503-388-7629
Practice Address - Street 1:4050 FAIRVIEW INDUSTRIAL DR SE STE 100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1006
Practice Address - Country:US
Practice Address - Phone:541-359-7770
Practice Address - Fax:503-388-7629
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor