Provider Demographics
NPI:1851311237
Name:CIRA-DICKERSON, CATHLEEN (DC)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:
Last Name:CIRA-DICKERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 LAUREL STREET
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070
Mailing Address - Country:US
Mailing Address - Phone:650-508-9111
Mailing Address - Fax:650-591-8800
Practice Address - Street 1:1701 LAUREL STREET
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070
Practice Address - Country:US
Practice Address - Phone:650-508-9111
Practice Address - Fax:650-591-8800
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor