Provider Demographics
NPI:1982044871
Name:DALTON CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:DALTON CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-448-1177
Mailing Address - Street 1:314 S FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-3114
Mailing Address - Country:US
Mailing Address - Phone:812-448-1177
Mailing Address - Fax:812-442-0378
Practice Address - Street 1:314 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-3114
Practice Address - Country:US
Practice Address - Phone:812-448-1177
Practice Address - Fax:812-442-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000542A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100079180AMedicaid
IN100079180AMedicaid