Individual
DUSTIN GAYLE TAVENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
213 N STETSON AVE, CHICAGO, IL 60601-7803
(312) 552-3000
(312) 552-3001
Mailing address
213 N STETSON AVE, CHICAGO, IL 60601-7803
(312) 552-3000
(312) 552-3001
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038011196
IL
Other
Enumeration date
04/14/2009
Last updated
02/05/2010
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