Provider Demographics
NPI:1407491004
Name:HINRICKSON, DILLON
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:
Last Name:HINRICKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3090 HIGHWAY 141
Mailing Address - Street 2:
Mailing Address - City:SMITHLAND
Mailing Address - State:IA
Mailing Address - Zip Code:51056-8061
Mailing Address - Country:US
Mailing Address - Phone:712-870-0486
Mailing Address - Fax:
Practice Address - Street 1:3090 HIGHWAY 141
Practice Address - Street 2:
Practice Address - City:SMITHLAND
Practice Address - State:IA
Practice Address - Zip Code:51056-8061
Practice Address - Country:US
Practice Address - Phone:712-870-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer