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General NPI Number Information
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NPI Number | 1649231051
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Entity Type | Individual
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Provider Name | DAVID D DYCK JR. D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 19550 E 39TH ST S SUITE 419
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City | INDEPENDENCE
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State | MO
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Zip | 64057-2358
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Country | US
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Telephone | 816-795-8200
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Fax | 816-795-7735
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Provider Business Mailing Address
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Address Line | 19550 E 39TH ST S STE 230
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City | INDEPENDENCE
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State | MO
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Zip | 64057-2309
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Country | US
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Telephone | 816-795-8200
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Fax | 816-795-7735
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 108810
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License Number State | MO
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