Provider Demographics
NPI:1801033972
Name:SHERMAN, DUSTIN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:JOHN
Last Name:SHERMAN
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 1:12124 LIMA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-9508
Mailing Address - Country:US
Mailing Address - Phone:260-637-4392
Mailing Address - Fax:260-637-1554
Practice Address - Street 1:12124 LIMA RD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-9508
Practice Address - Country:US
Practice Address - Phone:260-637-4392
Practice Address - Fax:260-637-1554
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002428A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor