Provider Demographics
NPI:1225228216
Name:DUTTON CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:DUTTON CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-384-7346
Mailing Address - Street 1:2216 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-3324
Mailing Address - Country:US
Mailing Address - Phone:719-384-7346
Mailing Address - Fax:719-384-2259
Practice Address - Street 1:2216 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-3324
Practice Address - Country:US
Practice Address - Phone:719-384-7346
Practice Address - Fax:719-384-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1165261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU03350Medicare UPIN
COK3503Medicare PIN