Provider Demographics
NPI:1306900592
Name:DALTON, DARLA S (DC)
Entity type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:S
Last Name:DALTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 STATE ROAD 32 E
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8729
Mailing Address - Country:US
Mailing Address - Phone:317-867-0123
Mailing Address - Fax:317-867-3636
Practice Address - Street 1:3008 STATE ROAD 32 E
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8729
Practice Address - Country:US
Practice Address - Phone:317-867-0123
Practice Address - Fax:317-867-3636
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002041A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200452220Medicaid
INU96556Medicare UPIN
IN208890Medicare ID - Type Unspecified