Provider Demographics
NPI:1598817652
Name:DICKASON, CLINTON SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:SAMUEL
Last Name:DICKASON
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 1:718 WILCOX ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1741
Mailing Address - Country:US
Mailing Address - Phone:303-688-2300
Mailing Address - Fax:303-688-2325
Practice Address - Street 1:718 WILCOX ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1741
Practice Address - Country:US
Practice Address - Phone:303-688-2300
Practice Address - Fax:303-688-2325
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
807809Medicare PIN