Healthcare Provider Details

I. General information

NPI: 1871563635
Provider Name (Legal Business Name): SUSAN CHRISTINE DILATUSH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 VINE ST
BENTON KY
42025-7472
US

IV. Provider business mailing address

PO BOX 1095
BENTON KY
42025-1095
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-0000
  • Fax: 270-527-2121
Mailing address:
  • Phone: 270-527-0000
  • Fax: 270-527-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1545
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1197
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5447
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: