Provider Demographics
NPI:1881706323
Name:DYER, PETER HARRY (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:HARRY
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 1:6232 E WOODHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-1492
Mailing Address - Country:US
Mailing Address - Phone:574-870-0022
Mailing Address - Fax:574-583-8991
Practice Address - Street 1:710 W FISHER ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-1737
Practice Address - Country:US
Practice Address - Phone:574-583-5418
Practice Address - Fax:574-583-8991
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000478A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100262550AMedicaid
IN920520Medicare UPIN
INU30904Medicare ID - Type Unspecified