Provider Demographics
NPI:1780116780
Name:DURGUT, ANSU (DC)
Entity type:Individual
Prefix:
First Name:ANSU
Middle Name:
Last Name:DURGUT
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 1:3139 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2205
Mailing Address - Country:US
Mailing Address - Phone:920-217-6052
Mailing Address - Fax:773-337-9106
Practice Address - Street 1:3139 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2205
Practice Address - Country:US
Practice Address - Phone:920-217-6052
Practice Address - Fax:773-337-9106
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor