Provider Demographics
NPI:1366422719
Name:FREDERICK-DAKIN, TONI (DC)
Entity type:Individual
Prefix:DR
First Name:TONI
Middle Name:
Last Name:FREDERICK-DAKIN
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 1:813 ELM ST.
Mailing Address - Street 2:PO BOX 98
Mailing Address - City:KENSETT
Mailing Address - State:IA
Mailing Address - Zip Code:50448-0098
Mailing Address - Country:US
Mailing Address - Phone:641-845-2405
Mailing Address - Fax:641-845-2405
Practice Address - Street 1:813 ELM ST.
Practice Address - Street 2:
Practice Address - City:KENSETT
Practice Address - State:IA
Practice Address - Zip Code:50448-0098
Practice Address - Country:US
Practice Address - Phone:641-845-2405
Practice Address - Fax:641-845-2405
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA46061OtherBLUE CROSS BLUE SHIELD
IA46061OtherBLUE CROSS BLUE SHIELD