Provider Demographics
NPI:1457826497
Name:DOUDNA, DALTON DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DALTON
Middle Name:DANIEL
Last Name:DOUDNA
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 1:2121 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-3523
Mailing Address - Country:US
Mailing Address - Phone:740-260-1635
Mailing Address - Fax:
Practice Address - Street 1:3536 JERSEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2223
Practice Address - Country:US
Practice Address - Phone:740-260-1635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor