Provider Demographics
NPI:1508194747
Name:DZIURGOT, MICHAEL WALTER (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WALTER
Last Name:DZIURGOT
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 1:1407 N RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4606
Mailing Address - Country:US
Mailing Address - Phone:847-849-9417
Mailing Address - Fax:847-368-1121
Practice Address - Street 1:1407 N RIDGE AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4606
Practice Address - Country:US
Practice Address - Phone:847-849-9417
Practice Address - Fax:847-368-1121
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor