Provider Demographics
NPI:1649810078
Name:DYER, JEREMIAH (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
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 1:33 E COUNTY LINE RD
Mailing Address - Street 2:STE A
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1078
Mailing Address - Country:US
Mailing Address - Phone:317-882-4922
Mailing Address - Fax:
Practice Address - Street 1:9601 E ILIFF AVE APT 1215
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3449
Practice Address - Country:US
Practice Address - Phone:317-504-5478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003169A111N00000X
COCHR.0008127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor