Provider Demographics
NPI:1871825604
Name:DGT CHIROPRACTIC SERVICES
Entity Type:Organization
Organization Name:DGT CHIROPRACTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:TAVENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-531-1244
Mailing Address - Street 1:213 N STETSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7803
Mailing Address - Country:US
Mailing Address - Phone:312-552-3000
Mailing Address - Fax:312-552-3001
Practice Address - Street 1:213 N STETSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7803
Practice Address - Country:US
Practice Address - Phone:312-552-3000
Practice Address - Fax:312-552-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011196261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care