Provider Demographics
NPI:1902859267
Name:DICKERSON, JAMES MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MICAEL
Other - Middle Name:
Other - Last Name:DICKERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC,
Mailing Address - Street 1:2592 N GREGG AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5543
Mailing Address - Country:US
Mailing Address - Phone:479-444-9449
Mailing Address - Fax:
Practice Address - Street 1:2592 N GREGG AVE
Practice Address - Street 2:STE 1
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5543
Practice Address - Country:US
Practice Address - Phone:479-444-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor