Provider Demographics
NPI:1043235732
Name:DYER, DEREK JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JAMES
Last Name:DYER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HOME ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-1346
Mailing Address - Country:US
Mailing Address - Phone:260-356-1616
Mailing Address - Fax:260-356-9779
Practice Address - Street 1:80 HOME ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1346
Practice Address - Country:US
Practice Address - Phone:260-356-1616
Practice Address - Fax:260-356-9779
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002240A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor