Provider Demographics
NPI:1619973898
Name:DICKERT, STEVEN B (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:DICKERT
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 1:58 WETHERHILL WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1610
Mailing Address - Country:US
Mailing Address - Phone:732-329-2255
Mailing Address - Fax:732-329-2228
Practice Address - Street 1:58 WETHERHILL WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1610
Practice Address - Country:US
Practice Address - Phone:732-329-2255
Practice Address - Fax:732-329-2228
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02937111N00000X
NYX003329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T52393Medicare UPIN
NJ540311Medicare PIN
NJ540311UNVMedicare PIN