Provider Demographics
NPI:1871978916
Name:ANDICKERSON, INC
Entity type:Organization
Organization Name:ANDICKERSON, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-554-9991
Mailing Address - Street 1:83 TEMPLETON DRIVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7019
Mailing Address - Country:US
Mailing Address - Phone:630-554-9991
Mailing Address - Fax:630-554-9992
Practice Address - Street 1:83 TEMPLETON DR
Practice Address - Street 2:UNIT C
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7019
Practice Address - Country:US
Practice Address - Phone:630-554-9991
Practice Address - Fax:630-554-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty