Provider Demographics
NPI:1457069288
Name:BREWER, DALTON JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:DALTON
Middle Name:JAMES
Last Name:BREWER
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 1:105 DAVIDSON ST E
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3580
Mailing Address - Country:US
Mailing Address - Phone:931-557-5111
Mailing Address - Fax:931-557-5112
Practice Address - Street 1:105 DAVIDSON ST E
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3580
Practice Address - Country:US
Practice Address - Phone:931-557-5111
Practice Address - Fax:931-557-5112
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000003650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor