MEDICARE: DR. JACOB DYSON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	095459	IA

General Provider Information

NPI Number	:	1104383025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB DYSON DC

Provider Business Mailing Address
First Line	:	955 236TH ST NE STE 1
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-9683
Country	:	US
Telephone Number	:	319-213-0497
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 236TH ST NE STE 1
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-9683
Country	:	US
Telephone Number	:	319-213-0497
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	03/16/2023

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Directions to “ DR. JACOB DYSON DC” Practice Location

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