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General NPI Number Information
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NPI Number | 1043083256
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Entity Type | Organization
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Legal Business Name | BRANDON DYKSTRA CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 9479 RILEY ST STE 245
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City | ZEELAND
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State | MI
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Zip | 49464-8750
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Country | US
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Telephone | 616-239-1105
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Fax |
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Provider Business Mailing Address
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Address Line | 9479 RILEY ST STE 245
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City | ZEELAND
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State | MI
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Zip | 49464-8750
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Country | US
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Telephone | 616-239-1105
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. BRANDON ROSS DYKSTRA
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Credential | DC
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Telephone | 616-239-1105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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