Individual
DR. TYLER J CHANTHAVONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2300 RIVERSIDE DR STE 122, GREEN BAY, WI 54301-1900
(920) 664-2559
Mailing address
803 FREDRICK CT APT 10, HOWARD, WI 54313-7994
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6307-12
WI
Other
Enumeration date
05/02/2025
Last updated
05/05/2025
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