Individual
DAKOTA BONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
237 26TH ST, OGDEN, UT 84401-3105
(801) 648-5288
Mailing address
237 26TH ST, OGDEN, UT 84401-3105
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
10877207-3502
UT
171M00000X
Case Manager/Care Coordinator
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000055266
MEDICARE PIN
UT
01
—
260022408
RAILROAD MEDICARE
UT
05
—
8760003008007
—
UT
Enumeration date
08/28/2017
Last updated
02/06/2020
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