Provider Demographics
NPI:1881623130
Name:MORTON, DUSTIN JON (DC)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JON
Last Name:MORTON
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 1:12840 SPRINKLE RD
Mailing Address - Street 2:#3
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-8395
Mailing Address - Country:US
Mailing Address - Phone:269-649-0800
Mailing Address - Fax:
Practice Address - Street 1:12840 SPRINKLE RD
Practice Address - Street 2:#3
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-8395
Practice Address - Country:US
Practice Address - Phone:269-649-0800
Practice Address - Fax:269-649-4000
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor