Provider Demographics
NPI:1326295783
Name:DICKENS, GARY ALBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALBERT
Last Name:DICKENS
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:G4150 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-1651
Mailing Address - Country:US
Mailing Address - Phone:810-742-1880
Mailing Address - Fax:810-742-1883
Practice Address - Street 1:G4150 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-1651
Practice Address - Country:US
Practice Address - Phone:810-742-1880
Practice Address - Fax:810-742-1883
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor