Provider Demographics
NPI:1063737815
Name:DIRCKX, JOHN H
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:DIRCKX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 RAVELLE CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1894
Mailing Address - Country:US
Mailing Address - Phone:937-258-0499
Mailing Address - Fax:
Practice Address - Street 1:260 RAVELLE CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1894
Practice Address - Country:US
Practice Address - Phone:937-258-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.027266208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice