Provider Demographics
NPI:1932167426
Name:FREDRICK, DAWSON EDWARD (DC)
Entity Type:Individual
Prefix:MR
First Name:DAWSON
Middle Name:EDWARD
Last Name:FREDRICK
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 1:2601 1ST AVE N
Mailing Address - Street 2:SUITE B
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1304
Mailing Address - Country:US
Mailing Address - Phone:906-233-9390
Mailing Address - Fax:906-233-9398
Practice Address - Street 1:2601 1ST AVE N
Practice Address - Street 2:SUITE B
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1304
Practice Address - Country:US
Practice Address - Phone:906-233-9390
Practice Address - Fax:906-233-9398
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4247060Medicaid
MI4247060Medicaid
MIU78466Medicare UPIN