Provider Demographics
NPI:1356560619
Name:DUTTON, DAVID MAX (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MAX
Last Name:DUTTON
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 1:2216 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-3324
Mailing Address - Country:US
Mailing Address - Phone:719-384-7346
Mailing Address - Fax:719-384-2259
Practice Address - Street 1:2216 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-3324
Practice Address - Country:US
Practice Address - Phone:719-384-7346
Practice Address - Fax:719-384-2259
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
K3503OtherMEDICARE CORP
U03350Medicare UPIN
K3513Medicare ID - Type Unspecified