Individual
DAVID D DYCK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
19550 E 39TH ST S, SUITE 419, INDEPENDENCE, MO 64057-2358
(816) 795-8200
(816) 795-7735
Mailing address
19550 E 39TH ST S STE 230, INDEPENDENCE, MO 64057-2309
(816) 795-8200
(816) 795-7735
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
108810
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080135929
RAILROAD MEDICARE
MO
05
—
100396370B
—
KS
05
—
100396370C
—
KS
05
—
1649231051
—
MO
Enumeration date
03/28/2006
Last updated
02/16/2022
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