Provider Demographics
NPI:1306966866
Name:DUKOWITZ, TROY J (DC)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:J
Last Name:DUKOWITZ
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 1:4980 BENCHMARK CENTRE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2041
Mailing Address - Country:US
Mailing Address - Phone:618-624-9080
Mailing Address - Fax:618-624-9090
Practice Address - Street 1:4980 BENCHMARK CENTRE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2041
Practice Address - Country:US
Practice Address - Phone:618-624-9080
Practice Address - Fax:618-624-9090
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK27457OtherMEDICARE ID
IL08232179OtherBLUE CROSS BLUE SHIELD
IL736013OtherHEALTHLINK
IL08232179OtherBLUE CROSS BLUE SHIELD