Provider Demographics
NPI:1558147975
Name:SMITH, DYLAN MARTINO (DC)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:MARTINO
Last Name:SMITH
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 1:140 JORDAN CREEK PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8485
Mailing Address - Country:US
Mailing Address - Phone:515-322-5448
Mailing Address - Fax:
Practice Address - Street 1:140 JORDAN CREEK PKWY STE 150
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8485
Practice Address - Country:US
Practice Address - Phone:515-322-5448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor