Provider Demographics
NPI:1205981347
Name:DICKASON CHIROPRACTIC PC
Entity type:Organization
Organization Name:DICKASON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:DICKASON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-688-2300
Mailing Address - Street 1:718 WILCOX ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1741
Mailing Address - Country:US
Mailing Address - Phone:303-688-2300
Mailing Address - Fax:303-688-2325
Practice Address - Street 1:718 WILCOX ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1741
Practice Address - Country:US
Practice Address - Phone:303-688-2300
Practice Address - Fax:303-688-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
807808Medicare PIN