Tyler Morgan Reisdorph, DC, MS

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

CH61137180 Issued in WA

Practice address

13003 SE Kent Kangley Rd Ste 110
Kent, WA 98030-7919

Phone

(253) 638-2424

NPI assigned

Mar 17, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1851976104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13003 SE KENT KANGLEY RD STE 110",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980307919",
            "telephone_number": "253-638-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13003 SE KENT KANGLEY RD STE 110",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980307919",
            "telephone_number": "253-638-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REISDORPH",
        "first_name": "TYLER",
        "middle_name": "MORGAN",
        "credential": "DC, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-17",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WA",
            "license": "CH61137180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Kent, WA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.