Provider Demographics
NPI:1134270689
Name:DUKART, JESSICA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:DUKART
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 I94 BUSINESS LOOP E # 1
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-6433
Mailing Address - Country:US
Mailing Address - Phone:701-483-8806
Mailing Address - Fax:701-483-8812
Practice Address - Street 1:1462 I94 BUSINESS LOOP E # 1
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-6433
Practice Address - Country:US
Practice Address - Phone:701-483-8806
Practice Address - Fax:701-483-8812
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5856111N00000X
ND825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0246770OtherBCBS OF AZ
AZAZ0246770OtherBCBS OF AZ
AZ23461Medicare ID - Type Unspecified