Provider Demographics
NPI:1093773228
Name:DYBOWSKI, RICHARD B (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:DYBOWSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45200 STERRITT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5844
Mailing Address - Country:US
Mailing Address - Phone:586-739-6080
Mailing Address - Fax:586-739-2797
Practice Address - Street 1:45200 STERRITT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5844
Practice Address - Country:US
Practice Address - Phone:586-739-6080
Practice Address - Fax:586-739-2797
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2090221Medicaid
MI2090221Medicaid