Provider Demographics
NPI:1609862119
Name:FINK, DUSTIN JOSEPH (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:JOSEPH
Last Name:FINK
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 WILDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 WILDWOOD CT
Practice Address - Street 2:
Practice Address - City:MOUNT ZION
Practice Address - State:IL
Practice Address - Zip Code:62549-1001
Practice Address - Country:US
Practice Address - Phone:217-412-0839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer