Healthcare Provider Details

I. General information

NPI: 1093773228
Provider Name (Legal Business Name): RICHARD B DYBOWSKI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45200 STERRITT ST SUITE 102
UTICA MI
48317-5844
US

IV. Provider business mailing address

45200 STERRITT ST SUITE 102
UTICA MI
48317-5844
US

V. Phone/Fax

Practice location:
  • Phone: 586-739-6080
  • Fax: 586-739-2797
Mailing address:
  • Phone: 586-739-6080
  • Fax: 586-739-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301002873
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: