Provider Demographics
NPI:1851804090
Name:ERIC J DICKERSON
Entity type:Organization
Organization Name:ERIC J DICKERSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-245-5146
Mailing Address - Street 1:124 CLYDESDALE CT STE K
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9540
Mailing Address - Country:US
Mailing Address - Phone:530-955-0065
Mailing Address - Fax:530-200-8865
Practice Address - Street 1:352 PROVIDENCE MINE RD
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2977
Practice Address - Country:US
Practice Address - Phone:530-955-0065
Practice Address - Fax:530-509-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty