Provider Demographics
NPI:1770554453
Name:LEINTZ, TYLER JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JAMES
Last Name:LEINTZ
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 1:448 21ST ST. W.
Mailing Address - Street 2:STE D2
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601
Mailing Address - Country:US
Mailing Address - Phone:701-483-6325
Mailing Address - Fax:701-483-6327
Practice Address - Street 1:448 21ST ST. W.
Practice Address - Street 2:STE D2
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601
Practice Address - Country:US
Practice Address - Phone:701-483-6325
Practice Address - Fax:701-483-6327
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13109Medicaid
NDN24105Medicare PIN
NDU98854Medicare UPIN