Provider Demographics
NPI:1861153934
Name:DALTON, MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:DALTON
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 1:585 E 400 S
Mailing Address - Street 2:
Mailing Address - City:RIVER HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5509
Mailing Address - Country:US
Mailing Address - Phone:801-255-0909
Mailing Address - Fax:
Practice Address - Street 1:169 N GATEWAY DR STE 130
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9737
Practice Address - Country:US
Practice Address - Phone:435-294-0619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12607268-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor