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General NPI Number Information
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NPI Number | 1215327887
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Entity Type | Organization
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Legal Business Name | DYLAID HOLDING CORPORATION
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 6040 RIVERSIDE DR STE C
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City | CHINO
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State | CA
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Zip | 91710-4494
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Country | US
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Telephone | 909-591-6233
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Fax |
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Provider Business Mailing Address
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Address Line | 6040 RIVERSIDE DR SUITE D
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City | CHINO
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State | CA
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Zip | 91710-4494
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. JEREMY HENRY BERNATH
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Credential | D.C.
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Telephone | 949-413-9186
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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 | DC 29689
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License Number State | CA
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