Provider Demographics
NPI:1003814302
Name:DICKSON, GERALD E (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:E
Last Name:DICKSON
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 1:8547 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2345
Mailing Address - Country:US
Mailing Address - Phone:330-856-6999
Mailing Address - Fax:330-856-2099
Practice Address - Street 1:8547 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2345
Practice Address - Country:US
Practice Address - Phone:330-856-6999
Practice Address - Fax:330-856-2099
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0949488Medicaid
OHDI0735242Medicare ID - Type Unspecified
OH0949488Medicaid