Provider Demographics
NPI:1659813988
Name:ZICKEFOOSE, DAKOTA LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAKOTA
Middle Name:LEE
Last Name:ZICKEFOOSE
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 1:241 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44842-1135
Mailing Address - Country:US
Mailing Address - Phone:419-994-2424
Mailing Address - Fax:567-223-6067
Practice Address - Street 1:241 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:OH
Practice Address - Zip Code:44842-1135
Practice Address - Country:US
Practice Address - Phone:419-994-2424
Practice Address - Fax:567-223-6067
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4643111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor