Provider Demographics
NPI:1417162496
Name:DJUKICH, DUSAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSAN
Middle Name:
Last Name:DJUKICH
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 1:131 W A ST STE 6
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-3437
Mailing Address - Country:US
Mailing Address - Phone:707-678-9278
Mailing Address - Fax:707-678-0824
Practice Address - Street 1:131 W A ST STE 6
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3437
Practice Address - Country:US
Practice Address - Phone:707-678-9278
Practice Address - Fax:707-678-0824
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0121550Medicare ID - Type Unspecified