Provider Demographics
NPI:1801243647
Name:ARVIDSON, TYLUR DAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:TYLUR
Middle Name:DAYNE
Last Name:ARVIDSON
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:PO BOX 8180
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-1180
Mailing Address - Country:US
Mailing Address - Phone:678-485-0260
Mailing Address - Fax:
Practice Address - Street 1:5302 YACHT HAVEN GRANDE
Practice Address - Street 2:S100
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-1180
Practice Address - Country:US
Practice Address - Phone:340-714-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI72111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor