Provider Demographics
NPI:1861971806
Name:VAN DYKE, CRISTIAN JEREMIAH (DPT)
Entity type:Individual
Prefix:DR
First Name:CRISTIAN
Middle Name:JEREMIAH
Last Name:VAN DYKE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2915
Mailing Address - Country:US
Mailing Address - Phone:605-630-9978
Mailing Address - Fax:
Practice Address - Street 1:1110 W OMAHA ST STE 3
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8119
Practice Address - Country:US
Practice Address - Phone:605-721-5950
Practice Address - Fax:605-721-5940
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20812081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine