Provider Demographics
NPI:1619692902
Name:FRICK, DALTON MICHAEL
Entity Type:Individual
Prefix:
First Name:DALTON
Middle Name:MICHAEL
Last Name:FRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 KEOKUK AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-1342
Mailing Address - Country:US
Mailing Address - Phone:712-348-2602
Mailing Address - Fax:
Practice Address - Street 1:514 1ST AVE
Practice Address - Street 2:
Practice Address - City:ARMSTRONG
Practice Address - State:IA
Practice Address - Zip Code:50514-7700
Practice Address - Country:US
Practice Address - Phone:712-868-3265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor