Provider Demographics
NPI:1639176274
Name:DIXON, TREV A (DC)
Entity Type:Individual
Prefix:DR
First Name:TREV
Middle Name:A
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 1:211 SOUTH ELM
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086
Mailing Address - Country:US
Mailing Address - Phone:817-599-3092
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:817-599-3092
Practice Address - Fax:817-613-1163
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C5883Medicare PIN
TXU37768Medicare UPIN