Provider Demographics
NPI:1902418833
Name:DINGUS, DUSTIN GAGE (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:GAGE
Last Name:DINGUS
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 1:1928 DUCK SLOUGH BLVD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5286
Mailing Address - Country:US
Mailing Address - Phone:727-514-8532
Mailing Address - Fax:
Practice Address - Street 1:1928 DUCK SLOUGH BLVD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5286
Practice Address - Country:US
Practice Address - Phone:727-514-8532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor