Provider Demographics
NPI:1518986892
Name:DUGAN, JOHN P (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:DUGAN
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:PO BOX 27647
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-7647
Mailing Address - Country:US
Mailing Address - Phone:928-775-5143
Mailing Address - Fax:928-775-0844
Practice Address - Street 1:8000 EAST HWY 69, #B
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-775-5143
Practice Address - Fax:928-775-0844
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0082690OtherBLUE CROSS BLUE SHIELD
AZ28130103OtherWORKERS COMP
AZ539794Medicaid
AZ539794Medicaid
AZT41570Medicare UPIN