Provider Demographics
NPI:1710078795
Name:SADULA, DUANE RAGIS (DC)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:RAGIS
Last Name:SADULA
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 1:16220 S FREDERICK AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4039
Mailing Address - Country:US
Mailing Address - Phone:301-977-3333
Mailing Address - Fax:301-977-5221
Practice Address - Street 1:16220 S FREDERICK AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:301-977-3333
Practice Address - Fax:301-977-5221
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD525374-01OtherBLUE SHIELD
MDU38760Medicare UPIN
MDO00256750Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MD470580Medicare ID - Type UnspecifiedTRAILBLAZER