Provider Demographics
NPI:1922065143
Name:DRAGAN, DOUGLAS WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:DRAGAN
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 1:1725 GRAND BLVD
Mailing Address - Street 2:PARK CENTRE
Mailing Address - City:MONESSEN
Mailing Address - State:PA
Mailing Address - Zip Code:15062
Mailing Address - Country:US
Mailing Address - Phone:724-684-8810
Mailing Address - Fax:724-684-8856
Practice Address - Street 1:1725 GRAND BLVD
Practice Address - Street 2:PARK CENTRE
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062
Practice Address - Country:US
Practice Address - Phone:724-684-8810
Practice Address - Fax:724-684-8856
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005157L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
176685OtherHIGHMARK
176685Medicare ID - Type Unspecified