Provider Demographics
NPI:1902567514
Name:GUNDERSON, TYLER GENE (DC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:GENE
Last Name:GUNDERSON
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 1:13670 CARMELLA LN APT A
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8480
Mailing Address - Country:US
Mailing Address - Phone:810-841-3323
Mailing Address - Fax:
Practice Address - Street 1:258 JAMES ST UNIT 10
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-1806
Practice Address - Country:US
Practice Address - Phone:616-396-6635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor