Provider Demographics
NPI:1295803922
Name:DICKINSON, JULIET C (DC)
Entity type:Individual
Prefix:DR
First Name:JULIET
Middle Name:C
Last Name:DICKINSON
Suffix:
Gender:F
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:PO BOX 2258
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-2258
Mailing Address - Country:US
Mailing Address - Phone:603-447-1144
Mailing Address - Fax:603-447-1133
Practice Address - Street 1:45 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6031
Practice Address - Country:US
Practice Address - Phone:603-447-1144
Practice Address - Fax:603-447-1133
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2015-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH535A0898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011587Medicaid
NHRE 4993Medicare ID - Type Unspecified
NH30011587Medicaid