Provider Demographics
NPI:1942296538
Name:DICUS, DONALD WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WAYNE
Last Name:DICUS
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 1:2003 PLEASANT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3867
Mailing Address - Country:US
Mailing Address - Phone:636-328-5762
Mailing Address - Fax:
Practice Address - Street 1:2241 BLUESTONE DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-6705
Practice Address - Country:US
Practice Address - Phone:636-328-5762
Practice Address - Fax:636-925-0128
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000165673111N00000X
IL038-008506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU82557Medicare UPIN
MO318543972Medicare PIN