Provider Demographics
NPI:1053097188
Name:GOZA, TYLER PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:PATRICK
Last Name:GOZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 N TYLER RD STE 100B
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4914
Mailing Address - Country:US
Mailing Address - Phone:316-619-1895
Mailing Address - Fax:
Practice Address - Street 1:2118 N TYLER RD STE 100B
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4914
Practice Address - Country:US
Practice Address - Phone:316-619-1895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06019111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner