Provider Demographics
NPI:1861886921
Name:DUKART, DUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:DUKART
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 1:321 BROADWAY AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:ST PAUL PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55071-1841
Mailing Address - Country:US
Mailing Address - Phone:612-314-9482
Mailing Address - Fax:
Practice Address - Street 1:321 BROADWAY AVE STE 14
Practice Address - Street 2:
Practice Address - City:ST PAUL PARK
Practice Address - State:MN
Practice Address - Zip Code:55071-1841
Practice Address - Country:US
Practice Address - Phone:612-314-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor