Provider Demographics
NPI:1447339395
Name:DYER, SIDNEY L (DC)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:L
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:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1043
Mailing Address - Country:US
Mailing Address - Phone:317-882-4922
Mailing Address - Fax:317-882-4898
Practice Address - Street 1:33 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1043
Practice Address - Country:US
Practice Address - Phone:317-882-4922
Practice Address - Fax:317-882-4898
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000951A111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN218740Medicare PIN
INU09824Medicare UPIN