Healthcare Provider Details

I. General information

NPI: 1780047936
Provider Name (Legal Business Name): ADAM DICKS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 N MAIN ST
SPANISH FORK UT
84660-1146
US

IV. Provider business mailing address

PO BOX 540610
N SALT LAKE UT
84054-0610
US

V. Phone/Fax

Practice location:
  • Phone: 385-225-0961
  • Fax: 385-448-5058
Mailing address:
  • Phone: 801-505-0821
  • Fax: 801-505-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number12044605-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: