Tyler Ottesen, DC | |
52 Route 17k Ste 203, Newburgh, NY 12550-3920 | |
(845) 565-5410 | |
Not Available |
Full Name | Tyler Ottesen |
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Gender | Male |
Speciality | Chiropractor |
Location | 52 Route 17k Ste 203, Newburgh, New York |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1295303436 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | X013461-01 (New York) | Primary |
Provider Name | Innate Chiropractic Pc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1366759797 PECOS PAC ID: 6800089913 Enrollment ID: O20101021000843 |
Mailing Address | Practice Location Address |
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Tyler Ottesen, DC 52 Route 17k Ste 203, Newburgh, NY 12550-3920 Ph: () - | Tyler Ottesen, DC 52 Route 17k Ste 203, Newburgh, NY 12550-3920 Ph: (845) 565-5410 |
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