Provider Demographics
NPI:1861084774
Name:MOTISKO, TYLER JAMES (DC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:MOTISKO
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 1:98 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:PA
Mailing Address - Zip Code:18641-2228
Mailing Address - Country:US
Mailing Address - Phone:570-955-8865
Mailing Address - Fax:570-451-3407
Practice Address - Street 1:98 GROVE ST
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:PA
Practice Address - Zip Code:18641-2228
Practice Address - Country:US
Practice Address - Phone:570-955-8865
Practice Address - Fax:570-451-3407
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PWDC011568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor