Provider Demographics
NPI:1639213291
Name:DICKERSON, ANITA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:ANN
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 E MAIN ST
Mailing Address - Street 2:A
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2374
Mailing Address - Country:US
Mailing Address - Phone:630-450-5515
Mailing Address - Fax:
Practice Address - Street 1:1434 E MAIN ST
Practice Address - Street 2:A
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2374
Practice Address - Country:US
Practice Address - Phone:630-450-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor