Provider Demographics
NPI:1891876363
Name:DUNGAN CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:DUNGAN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:JANETTE
Authorized Official - Last Name:DUNGAN MCPHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-985-6311
Mailing Address - Street 1:1227 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060
Mailing Address - Country:US
Mailing Address - Phone:810-985-6311
Mailing Address - Fax:810-985-3288
Practice Address - Street 1:1227 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-985-6311
Practice Address - Fax:810-985-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS006109111N00000X
MICD002683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U36203Medicare UPIN
MI0P04240Medicare ID - Type Unspecified