Individual
DR. CORINTHIAN ADOLPHOUS TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
7974 HAVEN AVE, RANCHO CUCAMONGA, CA 91730-3052
(909) 980-1985
Mailing address
7974 HAVEN AVE, RANCHO CUCAMONGA, CA 91730-3052
(909) 980-1985
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
34336
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34336
CHIROPRACTIC LICENSE
CA
Enumeration date
10/29/2018
Last updated
10/29/2018
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