Provider Demographics
NPI:1811554991
Name:MALZEWSKI, DAKOTA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAKOTA
Middle Name:ANN
Last Name:MALZEWSKI
Suffix:
Gender:F
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:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520-0039
Mailing Address - Country:US
Mailing Address - Phone:715-478-5202
Mailing Address - Fax:
Practice Address - Street 1:505 W GLEN ST
Practice Address - Street 2:
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520-1356
Practice Address - Country:US
Practice Address - Phone:715-478-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5442-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor