Provider Demographics
NPI:1578011235
Name:DIJKSTRA, DAVID LUKE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LUKE
Last Name:DIJKSTRA
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 1:10 COREY LN
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-3309
Mailing Address - Country:US
Mailing Address - Phone:973-525-7213
Mailing Address - Fax:
Practice Address - Street 1:10 COREY LN
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-3309
Practice Address - Country:US
Practice Address - Phone:973-525-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00735600111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician