Active NPI
Tyler Gravley
- Chiropractor
- Mandeville, LA
National Provider Identifier
1891285193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1807
- Practice address
- 2077 N Causeway Blvd
Suite 3
Mandeville, LA 70471 - Phone
- (504) 462-0242
- NPI assigned
- May 14, 2018
- Sex
- Male
- 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 | 1807 | LA | Primary |
Addresses
Primary practice location
2077 N Causeway Blvd
Suite 3
Mandeville, LA 70471
Mailing address
15211 Carlou Dr
Ponchatoula, LA 70454-6423
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1807 | LA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526601600000",
"number": "1891285193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15211 CARLOU DR",
"city": "PONCHATOULA",
"state": "LA",
"postal_code": "704546423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2077 N CAUSEWAY BLVD",
"address_2": "SUITE 3",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "70471",
"telephone_number": "504-462-0242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAVLEY",
"first_name": "TYLER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-05-14",
"last_updated": "2018-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Chiropractor",
"state": "LA",
"license": "1807",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mandeville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.