Provider Demographics
NPI:1851443360
Name:DICKINSON CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:DICKINSON CHIROPRACTIC, PC
Other - Org Name:DICKINSON FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-491-7777
Mailing Address - Street 1:3101 N GREEN RIVER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-1369
Mailing Address - Country:US
Mailing Address - Phone:812-491-7777
Mailing Address - Fax:812-491-7877
Practice Address - Street 1:3101 N GREEN RIVER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-1369
Practice Address - Country:US
Practice Address - Phone:812-491-7777
Practice Address - Fax:812-491-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN212440Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER