Provider Demographics
NPI:1356112395
Name:WASSERMAN, DYLAN (DC)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:WASSERMAN
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 1:285 W TABERNACLE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6960
Mailing Address - Country:US
Mailing Address - Phone:356-280-8414
Mailing Address - Fax:
Practice Address - Street 1:285 W TABERNACLE ST STE 102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6960
Practice Address - Country:US
Practice Address - Phone:356-280-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12764096-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor