Provider Demographics
NPI:1295404077
Name:DYER, ASHLEY A (DACM)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:DYER
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4303 N HERMITAGE AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1105
Mailing Address - Country:US
Mailing Address - Phone:515-710-5553
Mailing Address - Fax:
Practice Address - Street 1:118 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-3628
Practice Address - Country:US
Practice Address - Phone:312-548-8498
Practice Address - Fax:312-548-8497
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001574171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist