Provider Demographics
NPI:1215327887
Name:DYLAID HOLDING CORPORATION
Entity type:Organization
Organization Name:DYLAID HOLDING CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BERNATH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-413-9186
Mailing Address - Street 1:6040 RIVERSIDE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4494
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6040 RIVERSIDE DR
Practice Address - Street 2:STE C
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4494
Practice Address - Country:US
Practice Address - Phone:909-591-6233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty