Provider Demographics
NPI:1285667147
Name:WRIGHT, DUSTIN E (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:E
Last Name:WRIGHT
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:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-5245
Mailing Address - Country:US
Mailing Address - Phone:606-475-1366
Mailing Address - Fax:606-475-1367
Practice Address - Street 1:131 S CAROL MALONE BLVD STE D
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1810
Practice Address - Country:US
Practice Address - Phone:606-475-1366
Practice Address - Fax:606-475-1367
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4990111N00000X
WV857111N00000X
OH3780111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00822001Medicare PIN