Provider Demographics
NPI:1649614454
Name:HARGADINE, DUSTIN C (DC)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:C
Last Name:HARGADINE
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 1:249 CLARKSON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2497
Mailing Address - Country:US
Mailing Address - Phone:636-256-0707
Mailing Address - Fax:636-394-3969
Practice Address - Street 1:249 CLARKSON RD STE 101
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2497
Practice Address - Country:US
Practice Address - Phone:636-256-0707
Practice Address - Fax:636-394-3969
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011035233111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor