Healthcare Provider Details

I. General information

NPI: 1760881353
Provider Name (Legal Business Name): STEVEN DYKSTRA IOMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 E ORCHARD RD STE 200N
GREENWOOD VILLAGE CO
80111-2520
US

IV. Provider business mailing address

7600 E ORCHARD RD STE 200N
GREENWOOD VILLAGE CO
80111-2520
US

V. Phone/Fax

Practice location:
  • Phone: 303-339-1499
  • Fax: 303-962-4819
Mailing address:
  • Phone: 303-339-1499
  • Fax: 303-962-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: