Individual
MR. JOHN S. DYKSTRA X
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
9501 N OAK TRFY, SUITE 100, KANSAS CITY, MO 64155-2256
(816) 455-0661
(816) 454-1080
Mailing address
PO BOX 414975, KANSAS CITY, MO 64141-4975
(816) 455-0661
(816) 454-1080
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0516561
KS
2085R0202X
Diagnostic Radiology Physician
Primary
R4721
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03870079
BCBS
MO
01
—
067407
BCBS
KS
05
—
100231260A
—
KS
01
—
2239077
AETNA
MO
05
—
240394122
—
MO
Enumeration date
11/23/2005
Last updated
09/28/2010
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