Provider Demographics
NPI:1053537662
Name:DICK, DAVID W (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:DICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:512 W BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7021
Mailing Address - Country:US
Mailing Address - Phone:918-451-3737
Mailing Address - Fax:918-451-3741
Practice Address - Street 1:512 W BOSTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7021
Practice Address - Country:US
Practice Address - Phone:918-451-3737
Practice Address - Fax:918-451-3741
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor