Individual
DYLLN THANE RIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
39 S PARISH AVE UNIT 120, JOHNSTOWN, CO 80534-7855
(307) 359-2142
(970) 703-8151
Mailing address
338 ALDER AVE, JOHNSTOWN, CO 80534-9133
(970) 578-0082
(970) 703-8151
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0007783
CO
111NR0400X
Rehabilitation Chiropractor
0007783
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
853782542
1306349527
CO
Enumeration date
03/14/2018
Last updated
09/09/2022
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