Provider Demographics
NPI:1619156932
Name:DR TREV DIXON, D.C., P.A
Entity Type:Organization
Organization Name:DR TREV DIXON, D.C., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-613-1301
Mailing Address - Street 1:211 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4418
Mailing Address - Country:US
Mailing Address - Phone:817-613-1301
Mailing Address - Fax:817-613-1163
Practice Address - Street 1:211 S ELM ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4418
Practice Address - Country:US
Practice Address - Phone:817-613-1301
Practice Address - Fax:817-613-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00341XMedicare PIN