Provider Demographics
NPI:1407413941
Name:FREIBORG, DAKOTA TODD (DC)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:TODD
Last Name:FREIBORG
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 1:4777 19TH ST SW
Mailing Address - Street 2:APT 302
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2908
Mailing Address - Country:US
Mailing Address - Phone:320-905-5820
Mailing Address - Fax:
Practice Address - Street 1:14643 MERCANTILE DR N
Practice Address - Street 2:STE 110
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-4633
Practice Address - Country:US
Practice Address - Phone:320-905-5820
Practice Address - Fax:651-927-0229
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019016280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor