# COUNTRY DOC SHOP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750181376
- **Authorized official:** DAVID A DALTON DO (OWNER PROVIDER)
- **Authorized official phone:** (435) 233-6350

## Contact information

- **Practice address:** 555 S SUNSET DR, CEDAR CITY, UT 84720-3538
- **Practice address phone:** (435) 233-6350
- **Mailing address:** 2374 W NATURE VIEW DR, CEDAR CITY, UT 84720-1862
- **Mailing address phone:** (435) 233-6350
- **Mailing address fax:** (860) 718-3751

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | NULL | — |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/13/2025
- **Last updated:** 11/10/2025