Provider Demographics
NPI:1134207103
Name:DYE, BRUCE ALAN (CHIORPRACTOR DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
Last Name:DYE
Suffix:
Gender:M
Credentials:CHIORPRACTOR DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1314
Mailing Address - Country:US
Mailing Address - Phone:304-927-5907
Mailing Address - Fax:304-927-4836
Practice Address - Street 1:304 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1314
Practice Address - Country:US
Practice Address - Phone:304-927-5907
Practice Address - Fax:304-927-4836
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV275111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0468621Medicare ID - Type UnspecifiedMEDICARE
WVT32305Medicare UPIN