Provider Demographics
NPI:1417104423
Name:DIXON, BETHANY JUNE (DC, RD, LDN)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JUNE
Last Name:DIXON
Suffix:
Gender:F
Credentials:DC, RD, LDN
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:JUNE
Other - Last Name:DIGNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:26821 AGILE CT
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-1503
Mailing Address - Country:US
Mailing Address - Phone:727-457-6627
Mailing Address - Fax:
Practice Address - Street 1:26821 AGILE CT
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-1503
Practice Address - Country:US
Practice Address - Phone:727-457-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
FLCH11281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered