Provider Demographics
NPI:1174726459
Name:DICUS CHIROPRACTIC CLINIC, P.C.
Entity type:Organization
Organization Name:DICUS CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DICUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-328-5762
Mailing Address - Street 1:2003 PLEASANT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3867
Mailing Address - Country:US
Mailing Address - Phone:636-328-5762
Mailing Address - Fax:
Practice Address - Street 1:2241 BLUESTONE DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-6705
Practice Address - Country:US
Practice Address - Phone:636-328-5762
Practice Address - Fax:636-724-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty