Provider Demographics
NPI:1053448720
Name:DYAR, JOHN F JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:DYAR
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:F
Other - Last Name:DYAR
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:413 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1482
Mailing Address - Country:US
Mailing Address - Phone:205-661-0074
Mailing Address - Fax:205-661-0074
Practice Address - Street 1:413 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1482
Practice Address - Country:US
Practice Address - Phone:205-661-0074
Practice Address - Fax:205-661-0074
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51096289OtherBLUECROSS BLUESHIELD
ALU81242Medicare UPIN
AL51096289OtherBLUECROSS BLUESHIELD