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General NPI Number Information
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NPI Number | 1871825604
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Entity Type | Organization
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Legal Business Name | DGT CHIROPRACTIC SERVICES
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 213 N STETSON AVE
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City | CHICAGO
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State | IL
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Zip | 60601-7803
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Country | US
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Telephone | 312-552-3000
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Fax | 312-552-3001
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Provider Business Mailing Address
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Address Line | 213 N STETSON AVE
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City | CHICAGO
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State | IL
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Zip | 60601-7803
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Country | US
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Telephone | 312-552-3000
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Fax | 312-552-3001
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DUSTIN G TAVENNER
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Credential | D.C.
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Telephone | 406-531-1244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 038011196
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License Number State | IL
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