Healthcare Provider Details

I. General information

NPI: 1548003619
Provider Name (Legal Business Name): DAKOTA EDWARD JOHN FREEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 AIRWAY AVE BLDG H
COSTA MESA CA
92626-4607
US

IV. Provider business mailing address

4089 COUNTY ROAD E75
EDGERTON OH
43517-9371
US

V. Phone/Fax

Practice location:
  • Phone: 714-754-8008
  • Fax:
Mailing address:
  • Phone: 419-212-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC36985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: