Provider Demographics
NPI:1407995814
Name:DHILLON, SYDHIR S (DC)
Entity Type:Individual
Prefix:
First Name:SYDHIR
Middle Name:S
Last Name:DHILLON
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 1:1624 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3308
Mailing Address - Country:US
Mailing Address - Phone:805-641-2004
Mailing Address - Fax:805-641-2001
Practice Address - Street 1:1624 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3308
Practice Address - Country:US
Practice Address - Phone:805-641-2004
Practice Address - Fax:805-641-2001
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0295940OtherBLUE SHIELD
CADC29594Medicare ID - Type Unspecified
CADC0295940OtherBLUE SHIELD