Provider Demographics
NPI:1184719338
Name:DUNHAM, DAVID JAMES (DC,DPT,RN)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:DUNHAM
Suffix:
Gender:M
Credentials:DC,DPT,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6326 RUCKER RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220
Mailing Address - Country:US
Mailing Address - Phone:317-253-1644
Mailing Address - Fax:317-253-9708
Practice Address - Street 1:6326 RUCKER RD
Practice Address - Street 2:SUITE F
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4889
Practice Address - Country:US
Practice Address - Phone:317-253-1644
Practice Address - Fax:317-253-9708
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001746A111N00000X
IN05010034A225100000X
IN28195910A163W00000X
IN71006260A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
67506DMedicare Oscar/Certification
IN00000093076Medicare UPIN
U60694Medicare UPIN
168840Medicare PIN