Provider Demographics
NPI:1285792796
Name:DICKSON, DEANNA L (DOCTOR OF CHIROPRACT)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:L
Last Name:DICKSON
Suffix:
Gender:F
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:380 SOUTH LAKE AVE
Mailing Address - Street 2:SUITE #206
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101
Mailing Address - Country:US
Mailing Address - Phone:626-795-0564
Mailing Address - Fax:626-795-5786
Practice Address - Street 1:380 SOUTH LAKE AVE
Practice Address - Street 2:SUITE #206
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-795-0564
Practice Address - Fax:626-795-5786
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor