Healthcare Provider Details

I. General information

NPI: 1659813988
Provider Name (Legal Business Name): DAKOTA LEE ZICKEFOOSE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 W MAIN ST
LOUDONVILLE OH
44842-1135
US

IV. Provider business mailing address

241 W MAIN ST
LOUDONVILLE OH
44842-1135
US

V. Phone/Fax

Practice location:
  • Phone: 419-994-2424
  • Fax: 567-223-6067
Mailing address:
  • Phone: 419-994-2424
  • Fax: 567-223-6067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number4643
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: