Provider Demographics
NPI:1265417976
Name:DALTON, MICHAEL JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:DALTON
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:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-0217
Mailing Address - Country:US
Mailing Address - Phone:812-448-1897
Mailing Address - Fax:
Practice Address - Street 1:747 US HWY 40 EAST
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-7727
Practice Address - Country:US
Practice Address - Phone:812-448-1177
Practice Address - Fax:812-442-0378
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000542A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100079180AMedicaid
IN791350169Medicare PIN
IN100079180AMedicaid
IN130470Medicare ID - Type Unspecified