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General NPI Number Information
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NPI Number | 1275882516
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Entity Type | Organization
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Legal Business Name | JOHN H. DICKERSON DC PC
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 830 E 4TH ST SUITE 5
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City | ROYAL OAK
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State | MI
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Zip | 48067-2800
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Country | US
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Telephone | 248-584-4222
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Fax |
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Provider Business Mailing Address
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Address Line | 830 E 4TH ST SUITE 5
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City | ROYAL OAK
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State | MI
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Zip | 48067-2800
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Country | US
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Telephone | 248-584-4222
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN HENRY DICKERSON III
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Credential | DC
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Telephone | 248-802-7928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301006942
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License Number State | MI
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