Provider Demographics
NPI:1295323004
Name:DETTY, DALTON (DC)
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:
Last Name:DETTY
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 1:727 WINTER ST STE B
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-5949
Mailing Address - Country:US
Mailing Address - Phone:740-701-2988
Mailing Address - Fax:
Practice Address - Street 1:727 WINTER ST STE B
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-5949
Practice Address - Country:US
Practice Address - Phone:740-701-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor