Provider Demographics
NPI:1659149243
Name:DICKINSON, BRIAN L (DC, ATC, CPT)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:DICKINSON
Suffix:
Gender:M
Credentials:DC, ATC, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-1129
Mailing Address - Country:US
Mailing Address - Phone:585-617-4145
Mailing Address - Fax:585-617-4158
Practice Address - Street 1:3237 UNION ST
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-1129
Practice Address - Country:US
Practice Address - Phone:585-617-4145
Practice Address - Fax:585-617-4158
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1073220091OtherNPPES