Provider Demographics
NPI:1669582839
Name:DJCC, INC.
Entity type:Organization
Organization Name:DJCC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DYLYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANDERSCHAEGEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:906-932-4500
Mailing Address - Street 1:200 E AYER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-2070
Mailing Address - Country:US
Mailing Address - Phone:906-932-4500
Mailing Address - Fax:906-932-6329
Practice Address - Street 1:200 E AYER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-2070
Practice Address - Country:US
Practice Address - Phone:906-932-4500
Practice Address - Fax:906-932-6329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010068753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33285400Medicaid
MI3518033Medicaid
MI3518024Medicaid
MI3518024Medicaid