Provider Demographics
NPI:1821548165
Name:DYNAMIC CHIROPRACTIC
Entity Type:Organization
Organization Name:DYNAMIC CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WYATT
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-278-2225
Mailing Address - Street 1:8515 DOUGLAS AVE
Mailing Address - Street 2:STE. 25
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2915
Mailing Address - Country:US
Mailing Address - Phone:515-278-2225
Mailing Address - Fax:
Practice Address - Street 1:8515 DOUGLAS AVE
Practice Address - Street 2:STE. 25
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2915
Practice Address - Country:US
Practice Address - Phone:515-278-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1427347830Medicaid
IA1427347830Medicaid
IA1427347830Medicare UPIN