Healthcare Provider Details

I. General information

NPI: 1487239638
Provider Name (Legal Business Name): KEITH ALEXANDER DICKSON ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NE 3RD ST
MCMINNVILLE OR
97128-4901
US

IV. Provider business mailing address

119 NE 3RD ST
MCMINNVILLE OR
97128-4901
US

V. Phone/Fax

Practice location:
  • Phone: 503-434-6515
  • Fax: 503-472-5723
Mailing address:
  • Phone: 503-434-6515
  • Fax: 503-472-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number4377
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: