Provider Demographics
NPI:1780498790
Name:SMITKA, DYLAN DOUGLAS (DC)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:DOUGLAS
Last Name:SMITKA
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 1:11002 YONDER FLTS
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-0328
Mailing Address - Country:US
Mailing Address - Phone:361-944-5311
Mailing Address - Fax:
Practice Address - Street 1:1996 SCHERTZ PKWY UNIT 5
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1677
Practice Address - Country:US
Practice Address - Phone:210-960-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty