Provider Demographics
NPI:1972670776
Name:DYER, ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:DYER
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 1:887 WHITE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-9057
Mailing Address - Country:US
Mailing Address - Phone:618-307-3600
Mailing Address - Fax:618-307-3356
Practice Address - Street 1:860 BIESTER DR
Practice Address - Street 2:SUITE 103
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-4053
Practice Address - Country:US
Practice Address - Phone:815-544-3894
Practice Address - Fax:815-547-3968
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05207617OtherBCBS
ILU35070Medicare UPIN
IL05207617OtherBCBS