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General NPI Number Information
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NPI Number | 1760767214
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Entity Type | Organization
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Legal Business Name | DUDKO CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 8136 OLD KEENE MILL RD A314
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1850
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Country | US
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Telephone | 703-644-9311
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Fax | 703-644-3907
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Provider Business Mailing Address
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Address Line | 8136 OLD KEENE MILL RD A314
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1850
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Country | US
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Telephone | 703-644-9311
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Fax | 703-644-3907
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Authorized Official
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Title or Position | MEMBER-OWNER/CHIROPRACTOR
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Name | DR. SUZANNE DUDKO
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Credential | DC
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Telephone | 703-644-9311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 0104556122
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License Number State | VA
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