Dickerson Chiropractic and Wellness Center PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

DICKERSON CHIROPRACTIC AND WELLNESS CENTER PC

Practice address

100 N Main St
Suite 101
East Peoria, IL 61611-2533

Phone

(309) 699-7900

NPI assigned

Jul 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Thomas K Dickerson, DC, DICCPNPI 1548300163

Title

Owner

Phone

(309) 699-7900

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas Kevin Dickerson, D.C., D.I.C.C.P.

  • Chiropractor
  • Washington, IL
  • NPI 1548300163
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186358400000",
    "number": "1396944559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N MAIN ST",
            "address_2": "SUITE 101",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616112533",
            "telephone_number": "309-699-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MAIN ST",
            "address_2": "SUITE 101",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616112533",
            "telephone_number": "309-699-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKERSON CHIROPRACTIC AND WELLNESS CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-17",
        "last_updated": "2007-08-06",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-699-7900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC, DICCP"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in East Peoria, IL
• Providers in East Peoria, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.