Provider Demographics
NPI:1568465631
Name:DICKERSON, REX (DC)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:REX
Other - Middle Name:
Other - Last Name:DICKERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:103 GOEHMANN LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5307
Mailing Address - Country:US
Mailing Address - Phone:830-990-1660
Mailing Address - Fax:830-990-1407
Practice Address - Street 1:103 GOEHMANN LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5307
Practice Address - Country:US
Practice Address - Phone:830-990-1660
Practice Address - Fax:830-990-1407
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9558111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608126OtherBC & BS PROVIDER NUMBER
TX608126OtherBC & BS PROVIDER NUMBER
TXV04103Medicare UPIN