Provider Demographics
NPI:1740245778
Name:DIXON, ANGELA MILLER (DC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MILLER
Last Name:DIXON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-1916
Mailing Address - Country:US
Mailing Address - Phone:864-225-2583
Mailing Address - Fax:
Practice Address - Street 1:1500 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-1916
Practice Address - Country:US
Practice Address - Phone:864-226-0050
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2384Medicaid