Provider Demographics
NPI:1518991231
Name:DULGEROFF, DOUGLAS DAVID (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:DAVID
Last Name:DULGEROFF
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 1:7320 WOODLAKE AVE
Mailing Address - Street 2:SUITE 275
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1468
Mailing Address - Country:US
Mailing Address - Phone:818-883-4184
Mailing Address - Fax:818-883-4184
Practice Address - Street 1:7320 WOODLAKE AVE
Practice Address - Street 2:SUITE 275
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1468
Practice Address - Country:US
Practice Address - Phone:818-883-4184
Practice Address - Fax:818-883-4184
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 15911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC 15911Medicare ID - Type Unspecified