Provider Demographics
NPI:1245742063
Name:DAIES, DAULTON (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:DAULTON
Middle Name:
Last Name:DAIES
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-2427
Mailing Address - Country:US
Mailing Address - Phone:636-487-1160
Mailing Address - Fax:
Practice Address - Street 1:1020 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-1402
Practice Address - Country:US
Practice Address - Phone:636-487-1160
Practice Address - Fax:636-487-1160
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-012522083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine