Provider Demographics
NPI:1225315203
Name:DILATUSH CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DILATUSH CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:DILATUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-527-0000
Mailing Address - Street 1:PO BOX 1095
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-1095
Mailing Address - Country:US
Mailing Address - Phone:270-527-0000
Mailing Address - Fax:270-527-2121
Practice Address - Street 1:142 VINE ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-7472
Practice Address - Country:US
Practice Address - Phone:270-527-0000
Practice Address - Fax:270-527-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty