Provider Demographics
NPI:1548209265
Name:DICKINSON, TAMMY K (DC)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:K
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:2380 TROOP DR
Mailing Address - Street 2:UNIT 201
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4637
Mailing Address - Country:US
Mailing Address - Phone:763-504-0395
Mailing Address - Fax:763-559-7486
Practice Address - Street 1:2380 TROOP DR
Practice Address - Street 2:UNIT 201
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4637
Practice Address - Country:US
Practice Address - Phone:612-460-5674
Practice Address - Fax:320-317-0165
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN3572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN096225200Medicaid