Healthcare Provider Details

I. General information

NPI: 1417162496
Provider Name (Legal Business Name): DUSAN DJUKICH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W A ST STE 6
DIXON CA
95620-3437
US

IV. Provider business mailing address

131 W A ST STE 6
DIXON CA
95620-3437
US

V. Phone/Fax

Practice location:
  • Phone: 707-678-9278
  • Fax: 707-678-0824
Mailing address:
  • Phone: 707-678-9278
  • Fax: 707-678-0824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: