Provider Demographics
NPI:1184625154
Name:VAN HEMERT, LYLE R (DC)
Entity type:Individual
Prefix:DR
First Name:LYLE
Middle Name:R
Last Name:VAN HEMERT
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 1:3508 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6111
Mailing Address - Country:US
Mailing Address - Phone:605-331-4220
Mailing Address - Fax:
Practice Address - Street 1:3508 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6111
Practice Address - Country:US
Practice Address - Phone:605-331-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2007-08-02
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-06-27
Provider Licenses
StateLicense IDTaxonomies
SD797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7603880Medicaid
S3044Medicare PIN