Provider Demographics
NPI:1790141166
Name:DIXON, MARIAN IRIS (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:IRIS
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:MARIAN
Other - Middle Name:WOLFE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:6901 SE 65TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206
Mailing Address - Country:US
Mailing Address - Phone:503-232-7282
Mailing Address - Fax:503-232-7282
Practice Address - Street 1:3810 SE BELMONT ST.
Practice Address - Street 2:EARTHBODY WELLNESS CENTER EAST
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214
Practice Address - Country:US
Practice Address - Phone:971-337-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3902225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist