Provider Demographics
NPI:1083036883
Name:DUTTON, DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DUTTON
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 1:2622 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3967
Mailing Address - Country:US
Mailing Address - Phone:406-587-9679
Mailing Address - Fax:
Practice Address - Street 1:2622 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3967
Practice Address - Country:US
Practice Address - Phone:406-587-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC 2900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor