Healthcare Provider Details

I. General information

NPI: 1679505291
Provider Name (Legal Business Name): TIM DICKER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 11/05/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6906 FOOTHILL BLVD
TUJUNGA CA
91042-2713
US

IV. Provider business mailing address

6906 FOOTHILL BLVD
TUJUNGA CA
91042-2713
US

V. Phone/Fax

Practice location:
  • Phone: 818-352-1409
  • Fax: 818-352-1499
Mailing address:
  • Phone: 818-352-1409
  • Fax: 818-352-1499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number18385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: