Provider Demographics
NPI:1780742858
Name:DAKKEN, DANA JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:JOHN
Last Name:DAKKEN
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 1:117 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:IA
Mailing Address - Zip Code:50450-1303
Mailing Address - Country:US
Mailing Address - Phone:641-592-3301
Mailing Address - Fax:641-592-3301
Practice Address - Street 1:117 N MILL ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:IA
Practice Address - Zip Code:50450-1303
Practice Address - Country:US
Practice Address - Phone:641-592-3301
Practice Address - Fax:641-592-3301
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0122150OtherT19
IAT01046Medicare UPIN
IA18145Medicare ID - Type Unspecified