Provider Demographics
NPI:1427654631
Name:CONVERSE, DALTON
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:
Last Name:CONVERSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 BROOKPOINTE CIR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2091
Mailing Address - Country:US
Mailing Address - Phone:785-630-0519
Mailing Address - Fax:
Practice Address - Street 1:304 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COUNCIL GROVE
Practice Address - State:KS
Practice Address - Zip Code:66846-1707
Practice Address - Country:US
Practice Address - Phone:620-767-5860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor