Provider Demographics
NPI:1437714805
Name:DYRDAHL, BRANDON ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:ALLEN
Last Name:DYRDAHL
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 1:1680 MID VALLEY DR STE C
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9517
Mailing Address - Country:US
Mailing Address - Phone:920-658-5040
Mailing Address - Fax:920-658-5039
Practice Address - Street 1:1680 MID VALLEY DR STE C
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9517
Practice Address - Country:US
Practice Address - Phone:920-658-5040
Practice Address - Fax:920-658-5039
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5470-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1891904793OtherCLINIC NPI