Provider Demographics
NPI:1972097418
Name:NICKLE, TYLER (DO)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:NICKLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 RESEARCH PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1093
Mailing Address - Country:US
Mailing Address - Phone:719-445-6242
Mailing Address - Fax:719-445-6332
Practice Address - Street 1:2430 RESEARCH PKWY STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1093
Practice Address - Country:US
Practice Address - Phone:719-445-6242
Practice Address - Fax:719-445-6332
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A196902083X0100X
CODR.0074892208VP0000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine