Provider Demographics
NPI:1164183687
Name:BAKER, TYLER GREGORY (DC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:GREGORY
Last Name:BAKER
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 1:1054 E RIVERSIDE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4829
Mailing Address - Country:US
Mailing Address - Phone:661-733-5430
Mailing Address - Fax:
Practice Address - Street 1:1054 E RIVERSIDE DR STE 202
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4829
Practice Address - Country:US
Practice Address - Phone:661-733-5430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12600904-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT12600904-1202OtherDOPL OF UTAH