Provider Demographics
NPI:1588634869
Name:DICKS, ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:DICKS
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 1:1600 S 4TH AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2889
Mailing Address - Country:US
Mailing Address - Phone:309-263-5588
Mailing Address - Fax:
Practice Address - Street 1:1600 S 4TH AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2889
Practice Address - Country:US
Practice Address - Phone:309-263-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL560490Medicare ID - Type Unspecified
ILU58362Medicare UPIN