Healthcare Provider Details

I. General information

NPI: 1285667147
Provider Name (Legal Business Name): DUSTIN E WRIGHT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 S CAROL MALONE BLVD STE D
GRAYSON KY
41143-1810
US

IV. Provider business mailing address

PO BOX 1245
GRAYSON KY
41143-5245
US

V. Phone/Fax

Practice location:
  • Phone: 606-475-1366
  • Fax: 606-475-1367
Mailing address:
  • Phone: 606-475-1366
  • Fax: 606-475-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4990
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number857
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3780
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: