Provider Demographics
NPI:1649200577
Name:DINGSOR, BRYAN GARRY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:GARRY
Last Name:DINGSOR
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 1:2320 9TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-7112
Mailing Address - Country:US
Mailing Address - Phone:605-882-2304
Mailing Address - Fax:605-882-0626
Practice Address - Street 1:2320 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-7112
Practice Address - Country:US
Practice Address - Phone:605-882-2304
Practice Address - Fax:605-882-0626
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7601770Medicaid
SD41742Medicare ID - Type Unspecified
SDU98770Medicare UPIN