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Organization
COUNTRY DOC SHOP LLC
Active
Organization
COUNTRY DOC SHOP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID A DALTON DO (OWNER PROVIDER)
(435) 233-6350
Entity
Organization
Contact information
Practice address
555 S SUNSET DR, CEDAR CITY, UT 84720-3538
(435) 233-6350
Mailing address
2374 W NATURE VIEW DR, CEDAR CITY, UT 84720-1862
(435) 233-6350
(860) 718-3751
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
—
NULL
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
03/13/2025
Last updated
11/10/2025
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