Provider Demographics
NPI:1992825863
Name:DICKINSON, CHARLES WILFRED (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILFRED
Last Name:DICKINSON
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 1:45 W CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-2101
Mailing Address - Country:US
Mailing Address - Phone:508-528-2277
Mailing Address - Fax:
Practice Address - Street 1:45 W CENTRAL ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-2101
Practice Address - Country:US
Practice Address - Phone:508-528-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45007Medicare ID - Type Unspecified