Provider Demographics
NPI:1396334009
Name:BRENDE, DYLAN RYNE (DC)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:RYNE
Last Name:BRENDE
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 1:47478 252ND ST
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:SD
Mailing Address - Zip Code:57003-5920
Mailing Address - Country:US
Mailing Address - Phone:605-595-3508
Mailing Address - Fax:
Practice Address - Street 1:47478 252ND ST
Practice Address - Street 2:
Practice Address - City:BALTIC
Practice Address - State:SD
Practice Address - Zip Code:57003-5920
Practice Address - Country:US
Practice Address - Phone:605-595-3508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor