Provider Demographics
NPI:1174693402
Name:DALTON-SHERIDAN, DOROTHY LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:LYNN
Last Name:DALTON-SHERIDAN
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 1:316 SUMMIT HALL RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1824
Mailing Address - Country:US
Mailing Address - Phone:301-921-9271
Mailing Address - Fax:
Practice Address - Street 1:800 S FREDERICK AVE
Practice Address - Street 2:STE 213
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4152
Practice Address - Country:US
Practice Address - Phone:301-330-2000
Practice Address - Fax:301-330-2002
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01279111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522228180OtherFEDERAL TAX ID