Provider Demographics
NPI:1326172693
Name:DICKASON, MISTY MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:MICHELLE
Last Name:DICKASON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:MICHELLE
Other - Last Name:DURR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20-15 160TH STREET
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357
Mailing Address - Country:US
Mailing Address - Phone:626-388-5131
Mailing Address - Fax:
Practice Address - Street 1:20-15 160TH STREET
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357
Practice Address - Country:US
Practice Address - Phone:626-388-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011382111N00000X
VA0104556476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor