Provider Demographics
NPI:1376597682
Name:DIRKS, DAVID RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RICHARD
Last Name:DIRKS
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 1:360 CHERRY RUN CTR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4173
Mailing Address - Country:US
Mailing Address - Phone:252-362-0189
Mailing Address - Fax:252-495-0032
Practice Address - Street 1:360 CHERRY RUN CTR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4173
Practice Address - Country:US
Practice Address - Phone:252-362-0189
Practice Address - Fax:252-495-0032
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4969111N00000X
NC2267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU43828Medicare UPIN
MN3500004261Medicare PIN