Provider Demographics
NPI:1972163871
Name:DICKERSON, DANIEL (RD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 JUNIPER ST # 2
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1510
Mailing Address - Country:US
Mailing Address - Phone:267-733-7119
Mailing Address - Fax:866-473-0553
Practice Address - Street 1:708 JUNIPER ST # 2
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1510
Practice Address - Country:US
Practice Address - Phone:267-733-7119
Practice Address - Fax:866-473-0553
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2025-04-14
Deactivation Date:2019-06-13
Deactivation Code:
Reactivation Date:2019-06-19
Provider Licenses
StateLicense IDTaxonomies
133V00000X
PADN006742133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered