Individual
DR. DUSTIN J. DETRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C., L.C.P.
Contact information
Practice address
406 SOUTH MAIN STREET, FORT LORAMIE, OH 45845
(937) 420-4000
(937) 420-4001
Mailing address
21 MIAMI STREET, FORT LORAMIE, OH 45845
(937) 420-2500
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2482
OH
Other
Enumeration date
11/24/2006
Last updated
07/09/2007
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