Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2301010554 | MI |
N | 111N00000X | Chiropractor | 5702 | OR |
Y | 111NS0005X | Chiropractic Sports Physician | 2301010554 | MI |
NPI | 1346601879 |
---|---|
Provider Name | James Ryan Dietrick |
First Address | Big Rapids, MI 49307-2310 |
Second Address | Big Rapids, MI 49307-2310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2016 |
Last Update Date | 09/07/2019 |