Provider Demographics
NPI:1588605265
Name:DIXON, JOHN R (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:DIXON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 WOODBURY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-9617
Mailing Address - Country:US
Mailing Address - Phone:651-731-5124
Mailing Address - Fax:651-731-0509
Practice Address - Street 1:3060 WOODBURY DR
Practice Address - Street 2:SUITE A
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-9617
Practice Address - Country:US
Practice Address - Phone:651-731-5124
Practice Address - Fax:651-731-0509
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN178827200Medicaid
MN03N80DIOtherBCBS