Provider Demographics
NPI:1154732238
Name:DICKERSON, BENJAMIN SCOTT (DC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:DICKERSON
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 1:474 HIGHWAY 1 W
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-4204
Mailing Address - Country:US
Mailing Address - Phone:319-499-8158
Mailing Address - Fax:319-483-6627
Practice Address - Street 1:474 HIGHWAY 1 W
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-4204
Practice Address - Country:US
Practice Address - Phone:319-499-8158
Practice Address - Fax:319-483-6627
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor