Provider Demographics
NPI:1437403995
Name:DIMAK, CODY (DC)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:DIMAK
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 1:20301 BLUFFSIDE CIR APT 316
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-8523
Mailing Address - Country:US
Mailing Address - Phone:504-415-3418
Mailing Address - Fax:
Practice Address - Street 1:20301 BLUFFSIDE CIR APT 316
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-8523
Practice Address - Country:US
Practice Address - Phone:504-415-3418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor