MEDICARE: DR. JEREMIAH DYER 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	08003169A	IN
2	111N00000X	Chiropractor	CHR.0008127	CO

General Provider Information

NPI Number	:	1649810078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMIAH DYER DC

Provider Business Mailing Address
First Line	:	33 E COUNTY LINE RD
Second Line	:	STE A
City	:	GREENWOOD
State	:	IN
Zip	:	46143-1078
Country	:	US
Telephone Number	:	317-882-4922
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 E ILIFF AVE APT 1215
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-3449
Country	:	US
Telephone Number	:	317-504-5478
Fax Number	:

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

Provider Enumeration Date	:	01/14/2020
Last Update Date	:	10/02/2020

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