Individual
JERRY DICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2235
(817) 735-2480
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 735-2235
(817) 735-2480
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
F4805
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044103201
—
TX
01
—
120001842
RAILROAD MEDICARE
TX
01
—
859571
BCBS
TX
Enumeration date
02/08/2006
Last updated
02/05/2009
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