Provider Demographics
NPI:1215567805
Name:BRUNNER, DALTON JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:DALTON
Middle Name:JAMES
Last Name:BRUNNER
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 1:6308 MONROVIA ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-2740
Mailing Address - Country:US
Mailing Address - Phone:913-279-1598
Mailing Address - Fax:
Practice Address - Street 1:6308 MONROVIA ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-2740
Practice Address - Country:US
Practice Address - Phone:913-279-1598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor