Individual
JACK TIAHNYBIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1120 W MICHIGAN ST # CL642, INDIANAPOLIS, IN 46202-5209
(317) 278-2686
Mailing address
1120 W MICHIGAN ST # CL642, INDIANAPOLIS, IN 46202-5209
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/05/2021
Last updated
04/05/2021
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