Provider Demographics
NPI:1215018718
Name:DICKSON, JAY WARNER (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:WARNER
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 1:13525 MIDLAND RD
Mailing Address - Street 2:G
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4771
Mailing Address - Country:US
Mailing Address - Phone:858-748-1432
Mailing Address - Fax:858-748-1433
Practice Address - Street 1:13525 MIDLAND RD
Practice Address - Street 2:SUITE G
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4771
Practice Address - Country:US
Practice Address - Phone:858-748-1432
Practice Address - Fax:858-748-1433
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 17097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor