Active NPI
Tyler Renee Wade, DC
- Chiropractor
- Dallas, GA
National Provider Identifier
1720814643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CHIR0112668
- Practice address
- 166 Parkmont Way
Dallas, GA 30132-1121 - Phone
- (313) 415-6908
- NPI assigned
- Sep 9, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CHIR0112668 | GA | Primary |
Addresses
Primary practice location
166 Parkmont Way
Dallas, GA 30132-1121
Mailing address
166 Parkmont Way
Dallas, GA 30132-1121
Phone (313) 415-6908
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIR0112668 | GA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aica Orthopedics, P. C. | Past | Accepting new patients |
Interoperability endpoints
- tyler.wade.p1@direct.aicaorthopedics.nextgenshare.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinic/Center
- Conyers, GA
- NPI 1689257388
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725840000000",
"number": "1720814643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "166 PARKMONT WAY",
"city": "DALLAS",
"state": "GA",
"postal_code": "301321121",
"telephone_number": "313-415-6908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "166 PARKMONT WAY",
"city": "DALLAS",
"state": "GA",
"postal_code": "301321121",
"telephone_number": "313-415-6908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "TYLER",
"middle_name": "RENEE",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-09-09",
"last_updated": "2024-09-09",
"certification_date": "2024-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "GA",
"license": "CHIR0112668",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.