Provider Demographics
NPI:1417267279
Name:FREAD, DUSTIN EZRA (DC)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:EZRA
Last Name:FREAD
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 1:5308 PARKLANE DR
Mailing Address - Street 2:#5
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5308 PARKLANE DR
Practice Address - Street 2:#5
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8630
Practice Address - Country:US
Practice Address - Phone:308-237-0648
Practice Address - Fax:308-236-9197
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1632111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor