Tyler Wayne Vitzthum, D.C.
Individual provider Active NPI Chiropractor · Fairfield, CT
NPI 1245686997 · NPPES record last updated May 12, 2016
Key facts
- NPI
- 1245686997
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2032 (CT)
- Practice address
- 1995 Post Rd.
Fairfield, CT 06824 - Phone
- (203) 259-1555
- NPI assigned
- May 12, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bodyworks Medical Center of West Dundee PLLC
Practice addresses (Care Compare)
754 S 8TH St
West Dundee, IL 60118-2102
Phone (630) 517-5817
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221207003150 | IL | Practitioner - Chiropractic | 9638432826 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2032 | CT | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Evolve Chiropractic Lake Zurich PLLC | Chiropractor | Current |
Accepting new patients |
| Bodyworks Medical Center of West Dundee PLLC | Current |
Accepting new patients | |
| Lakeside Chiropractic LLC | Chiropractor | Current | Accepting new patients |
| Chiropractic Health & Wellness Center LLC | Chiropractor | Past |
Accepting new patients |
| Southport Chiropractic Office, P.C. | Past | Accepting new patients |
Locations
275 S Rand Rd
Ste A9
Lake Zurich, IL 60047
Phone (224) 662-4732
754 S 8th St
West Dundee, IL 60118
Phone (630) 517-5817
5024 Green Bay Rd
Ste 100
Kenosha, WI 53144
Phone (262) 657-8434
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2032 | CT | Yes |
Addresses
Primary practice location
1995 Post Rd.
Fairfield, CT 06824
Mailing address
1995 Post Rd.
Fairfield, CT 06824
Phone (203) 259-1555
Other providers in Fairfield, CT
- Anthony Viola III
- Pramila Vishvanath
- Visology Inc
- Rene' Visser
- Donna S Vitulano
- Vivonova Health PLLC
- Cailin Vizzo
- Barbara J Vogel
- Vori Health Medical Group PLLC
- Vori Health Medical Group PLLC
All providers in Fairfield, CT · Chiropractor in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.