Provider Demographics
NPI:1881938256
Name:ANDRES, TYLER N (LAC)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:N
Last Name:ANDRES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 SE SUNNYBROOK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6805
Mailing Address - Country:US
Mailing Address - Phone:503-607-2226
Mailing Address - Fax:
Practice Address - Street 1:8810 SE SUNNYBROOK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:503-607-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-25
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC 159975171100000X
WAAC60351775171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist