Provider Demographics
NPI:1902990732
Name:DICKER, DIANE HELEN (DC)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:HELEN
Last Name:DICKER
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 1:141 W WIEUCA RD NE
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3251
Mailing Address - Country:US
Mailing Address - Phone:404-257-0310
Mailing Address - Fax:404-257-0310
Practice Address - Street 1:141 W WIEUCA RD NE
Practice Address - Street 2:SUITE 100A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3251
Practice Address - Country:US
Practice Address - Phone:404-257-0310
Practice Address - Fax:404-257-0310
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA4870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U70724Medicare UPIN
GA35ZCHVLMedicare ID - Type Unspecified