Brandon Dykstra Chiropractic LLC
Organization Active NPI Chiropractor · Zeeland, MI
NPI 1043083256 · NPPES record last updated Oct 31, 2023
Key facts
- NPI
- 1043083256
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- BRANDON DYKSTRA CHIROPRACTIC LLC
- Practice address
- 9479 Riley St Ste 245
Zeeland, MI 49464-8750 - Phone
- (616) 239-1105
- NPI assigned
- Oct 31, 2023
- Organization subpart
- No
Authorized official
- Name
- Dr. Brandon Ross Dykstra, DC
- Title
- Chiropractor
- Phone
- (616) 239-1105
Practitioners 1
-
Brandon Dykstra, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240116003496 | MI | Part B Supplier - Clinic/Group Practice | 6507218492 |
Receives reassigned benefits from 1 practitioner Practice locations: Zeeland, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
9479 Riley St Ste 245
Zeeland, MI 49464-8750
Mailing address
9479 Riley St Ste 245
Zeeland, MI 49464-8750
Phone (616) 239-1105
Other providers in Zeeland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.