Healthcare Provider Details

I. General information

NPI: 1376180604
Provider Name (Legal Business Name): VLADIMIR DJURIC DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12960 LILLIAN HWY
PENSACOLA FL
32506-8423
US

IV. Provider business mailing address

12960 LILLIAN HWY
PENSACOLA FL
32506-8423
US

V. Phone/Fax

Practice location:
  • Phone: 850-741-4389
  • Fax:
Mailing address:
  • Phone: 850-741-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH12889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: