Provider Demographics
NPI:1245440395
Name:ANDRUS, DWIGHT EUGENE (DC)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:EUGENE
Last Name:ANDRUS
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 1:301 E TABERNACLE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7108
Mailing Address - Country:US
Mailing Address - Phone:435-632-5555
Mailing Address - Fax:
Practice Address - Street 1:3118 S BLOOMINGTON DR W
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7666
Practice Address - Country:US
Practice Address - Phone:435-632-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT165612-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT48890Medicare UPIN