Healthcare Provider Details

I. General information

NPI: 1417997529
Provider Name (Legal Business Name): EDWARD J DYSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 SICKLERVILLE RD
SICKLERVILLE NJ
08081-2626
US

IV. Provider business mailing address

504 SICKLERVILLE RD
SICKLERVILLE NJ
08081-2626
US

V. Phone/Fax

Practice location:
  • Phone: 856-875-1515
  • Fax:
Mailing address:
  • Phone: 856-875-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberDC005560L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: