Provider Demographics
NPI:1043083256
Name:BRANDON DYKSTRA CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BRANDON DYKSTRA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:DYKSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-239-1105
Mailing Address - Street 1:9479 RILEY ST STE 245
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-8750
Mailing Address - Country:US
Mailing Address - Phone:616-239-1105
Mailing Address - Fax:
Practice Address - Street 1:9479 RILEY ST STE 245
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-8750
Practice Address - Country:US
Practice Address - Phone:616-239-1105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty