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NPI Code Detail

MEDICARE: DR DUSTIN BOUWHUIS CHIROPRACTIC CORP

MEDICARE: DR DUSTIN BOUWHUIS CHIROPRACTIC CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111NS0005XSports Physician Chiropractor31527CA

General Provider Information

NPI Number : 1205173945
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR DUSTIN BOUWHUIS CHIROPRACTIC CORP
Provider Business Mailing Address
First Line : 24582 DEL PRADO STE H
Second Line :
City : DANA POINT
State : CA
Zip : 92629-3821
Country : US
Telephone Number : 949-487-2722
Fax Number : 949-487-2723
Provider Business Practice Location Address
First Line : 24582 DEL PRADO STE H
Second Line :
City : DANA POINT
State : CA
Zip : 92629-3821
Country : US
Telephone Number : 949-487-2722
Fax Number : 949-487-2723
Authorized Official
Title or Position : OWNER
Name : DUSTIN BOUWHUIS
Credential : D.C.
Telephone Number : 949-487-2722
Provider Enumeration Date : 01/15/2013
Last Update Date : 01/15/2013

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Directions to “DR DUSTIN BOUWHUIS CHIROPRACTIC CORP ” Practice Location

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