Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 4568 | OH |
N | 111NR0400X | Rehabilitation Chiropractor | 4568 | OH |
Y | 111NS0005X | Chiropractic Sports Physician | 4568 | OH |
N | 111NS0005X | Chiropractic Sports Physician | OH-04568 | OH |
N | 111NX0100X | Occupational Health | 4568 | OH |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 4568 | OH |
NPI | 1386016665 |
---|---|
Provider Name | Dr. Tyler T Lanning |
First Address | Bellbrook, OH 45305-2315 |
Second Address | Bellbrook, OH 45305-2315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2015 |
Last Update Date | 03/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13644841 | CAQH (01) | OH |
H445331 | (05) | OH |