Provider Demographics
NPI:1538923578
Name:DURKE, DUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:DURKE
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 1:7815 E TARMA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3139
Mailing Address - Country:US
Mailing Address - Phone:562-279-5137
Mailing Address - Fax:
Practice Address - Street 1:625 FAIR OAKS AVE STE 119
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2684
Practice Address - Country:US
Practice Address - Phone:626-345-5710
Practice Address - Fax:626-345-5831
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor