Provider Demographics
NPI:1558458372
Name:DAHMER, DAVID K (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:DAHMER
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 1:13315 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-4888
Mailing Address - Country:US
Mailing Address - Phone:352-596-1900
Mailing Address - Fax:352-596-9888
Practice Address - Street 1:13315 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-4888
Practice Address - Country:US
Practice Address - Phone:352-596-1900
Practice Address - Fax:352-596-9888
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88752OtherBLUE SHILED
FL380641300Medicaid
FL88752YMedicare PIN
FLT95236Medicare UPIN