Provider Demographics
NPI:1770771198
Name:DIMICK, JEFFREY M (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:DIMICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8202 CLEARVISTA PKWY
Mailing Address - Street 2:SUITE 9D
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1400
Mailing Address - Country:US
Mailing Address - Phone:317-578-7544
Mailing Address - Fax:317-578-9604
Practice Address - Street 1:8202 CLEARVISTA PKWY
Practice Address - Street 2:SUITE 9D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1400
Practice Address - Country:US
Practice Address - Phone:317-578-7544
Practice Address - Fax:317-578-9604
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002058A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INV04512Medicare UPIN
IN225390Medicare PIN