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NPI Code Detail

MEDICARE: DR. DUSTIN J BOUWHUIS D.C.

MEDICARE: DR. DUSTIN J BOUWHUIS D.C.
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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
146-1743657OTHERCORPORATION TAX ID

General Provider Information

NPI Number : 1861705568
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DUSTIN J BOUWHUIS D.C.
Provider Business Mailing Address
First Line : 24585 DEL PRADO STE H
Second Line :
City : DANA POINT
State : CA
Zip : 92629
Country : US
Telephone Number : 949-487-2722
Fax Number : 949-487-2723
Provider Business Practice Location Address
First Line : 24585 DEL PRADO
Second Line : SUITE H
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 :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2010
Last Update Date : 05/15/2013

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