Provider Demographics
NPI:1720514698
Name:DICKSHINSKI, DANIELLE ELIZABETH (LAC)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ELIZABETH
Last Name:DICKSHINSKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7544 E DRUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-2041
Mailing Address - Country:US
Mailing Address - Phone:203-687-0069
Mailing Address - Fax:
Practice Address - Street 1:7544 E DRUMMER AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-2041
Practice Address - Country:US
Practice Address - Phone:203-687-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1068171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist