Individual
DYLAN FILLWOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2000 W UNIVERSITY AVE, MUNCIE, IN 47306-1022
(765) 289-1241
Mailing address
1111 MARSHLYN DR, NILES, MI 49120
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/25/2021
Last updated
06/25/2021
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