Provider Demographics
NPI:1659616548
Name:DIXON CHIROPRACTIC
Entity Type:Organization
Organization Name:DIXON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-395-3303
Mailing Address - Street 1:249 BOND SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:MO
Mailing Address - Zip Code:65064-2120
Mailing Address - Country:US
Mailing Address - Phone:573-301-7268
Mailing Address - Fax:
Practice Address - Street 1:7806 ROUTE M
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-9549
Practice Address - Country:US
Practice Address - Phone:573-395-3303
Practice Address - Fax:573-395-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000170551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty