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Individual

DR. TYLER LANE QUALLS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
7651 TCHULAHOMA RD, SOUTHAVEN, MS 38671-9227
(662) 349-0980
(662) 349-0990
Mailing address
7651 TCHULAHOMA RD, SOUTHAVEN, MS 38671-9227
(662) 349-0980
(662) 349-0990

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1147
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
302I355410
MEDICARE PTAN
MS
Enumeration date
04/27/2009
Last updated
03/19/2025
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