Provider Demographics
NPI:1932705530
Name:JONLYNN, DYLAN (DC)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:JONLYNN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:DYLAN
Other - Middle Name:
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3970 BROADWAY ST STE 201E
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1163
Mailing Address - Country:US
Mailing Address - Phone:303-264-7618
Mailing Address - Fax:
Practice Address - Street 1:3970 BROADWAY ST STE 201E
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1163
Practice Address - Country:US
Practice Address - Phone:303-264-7618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty