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General NPI Number Information
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NPI Number | 1376725689
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Entity Type | Organization
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Legal Business Name | DUGGER CHIROPRACTIC CENTER, P.C.
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 104 N STATE ST
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City | JERSEYVILLE
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State | IL
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Zip | 62052-1701
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Country | US
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Telephone | 618-498-3447
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Fax | 618-498-1607
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Provider Business Mailing Address
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Address Line | 104 N STATE ST
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City | JERSEYVILLE
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State | IL
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Zip | 62052-1701
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Country | US
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Telephone | 618-498-3447
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Fax | 618-498-1607
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BLAKE DUGGER
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Credential | D.C.
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Telephone | 618-498-3447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State | IL
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