Provider Demographics
NPI:1033254404
Name:FIKE, DAK R (DC)
Entity Type:Individual
Prefix:DR
First Name:DAK
Middle Name:R
Last Name:FIKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 1ST AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-2147
Mailing Address - Country:US
Mailing Address - Phone:406-628-4622
Mailing Address - Fax:
Practice Address - Street 1:720 1ST AVE STE 2
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-2147
Practice Address - Country:US
Practice Address - Phone:406-628-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY582111N00000X
MT3997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW20318Medicare PIN
WYU77419Medicare UPIN