Provider Demographics
NPI:1427641661
Name:JOEL DICKSON CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:JOEL DICKSON CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-505-7008
Mailing Address - Street 1:11294 COLOMA RD STE H
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4486
Mailing Address - Country:US
Mailing Address - Phone:916-778-6523
Mailing Address - Fax:
Practice Address - Street 1:11294 COLOMA RD STE H
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4486
Practice Address - Country:US
Practice Address - Phone:916-778-6523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty