Provider Demographics
NPI:1013344134
Name:DUNN, MICHAEL ROY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROY
Last Name:DUNN
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 1:2395 TECH DR STE 4
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3277
Mailing Address - Country:US
Mailing Address - Phone:563-265-5235
Mailing Address - Fax:563-888-5449
Practice Address - Street 1:2395 TECH DR STE 4
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3277
Practice Address - Country:US
Practice Address - Phone:563-265-5235
Practice Address - Fax:563-888-5449
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA815124138Medicaid