Provider Demographics
NPI:1376813998
Name:DICKINSON FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:DICKINSON FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-341-7047
Mailing Address - Street 1:28105 TOMBALL PKWY
Mailing Address - Street 2:SUITE 106A
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3340
Mailing Address - Country:US
Mailing Address - Phone:832-341-7047
Mailing Address - Fax:
Practice Address - Street 1:28105 TOMBALL PKWY
Practice Address - Street 2:SUITE 106A
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3340
Practice Address - Country:US
Practice Address - Phone:832-341-7047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1437428174OtherNPI TYPE 1