Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1842 | OH |
NPI | 1003814302 |
---|---|
Provider Name | Dr. Gerald E Dickson |
First Address | Warren, OH 44484-2345 |
Second Address | Warren, OH 44484-2345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 24/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0949488 | (05) | OH |
U40523 | (02) | OH |