Provider Demographics
NPI:1659512598
Name:DICKERSON, ASHLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
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 1:83 TEMPLETON DR
Mailing Address - Street 2:UNIT C
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7019
Mailing Address - Country:US
Mailing Address - Phone:309-453-0579
Mailing Address - Fax:
Practice Address - Street 1:83 TEMPLETON DR
Practice Address - Street 2:UNIT C
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7019
Practice Address - Country:US
Practice Address - Phone:309-453-0579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor