Provider Demographics
NPI:1144222076
Name:DZIURA, DAVID B (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:DZIURA
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 1:650 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3613
Mailing Address - Country:US
Mailing Address - Phone:203-481-6150
Mailing Address - Fax:203-481-0411
Practice Address - Street 1:650 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3613
Practice Address - Country:US
Practice Address - Phone:203-481-6150
Practice Address - Fax:203-481-0411
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0461111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22992Medicare UPIN
CT350001290Medicare ID - Type Unspecified