Provider Demographics
NPI:1689130023
Name:TOLLIVER, DALTON (DC)
Entity Type:Individual
Prefix:MISS
First Name:DALTON
Middle Name:
Last Name:TOLLIVER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 ALFORD PL STE 5
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3349
Mailing Address - Country:US
Mailing Address - Phone:904-582-5200
Mailing Address - Fax:
Practice Address - Street 1:1563 ALFORD PL STE 5
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3349
Practice Address - Country:US
Practice Address - Phone:904-582-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13205111N00000X, 111N00000X
MDS04043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor