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General NPI Number Information
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NPI Number | 1538923578
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Entity Type | Individual
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Provider Name | DUSTIN DURKE DC
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Gender | Male
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Dates
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Enumeration Date | 02/09/2024
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 625 FAIR OAKS AVE STE 119
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-2684
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Country | US
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Telephone | 626-345-5710
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Fax | 626-345-5831
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Provider Business Mailing Address
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Address Line | 7815 E TARMA ST
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City | LONG BEACH
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State | CA
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Zip | 90808-3139
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Country | US
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Telephone | 562-279-5137
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC36894
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License Number State | CA
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