Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 469 | OR |
N | 175L00000X | Homeopath | 469 | OR |
NPI | 1831147784 |
---|---|
Provider Name | Dr. Bruce Dickson |
First Address | Mcminnville, OR 97128-4901 |
Second Address | Mcminnville, OR 97128-4901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 08/07/2007 |