Provider Demographics
NPI:1083338206
Name:DICKINSON CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DICKINSON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:225-665-3969
Mailing Address - Street 1:PO BOX 83080
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-3080
Mailing Address - Country:US
Mailing Address - Phone:225-665-3969
Mailing Address - Fax:
Practice Address - Street 1:516 N RANGE AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-2932
Practice Address - Country:US
Practice Address - Phone:225-665-3969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1900H1889ZOtherBLUE CROSS LOUISIANA