Provider Demographics
NPI:1679505291
Name:DICKER, TIM (DC)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:
Last Name:DICKER
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 1:6906 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2713
Mailing Address - Country:US
Mailing Address - Phone:818-352-1409
Mailing Address - Fax:818-352-1499
Practice Address - Street 1:6906 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2713
Practice Address - Country:US
Practice Address - Phone:818-352-1409
Practice Address - Fax:818-352-1499
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18385Medicare UPIN