Provider Demographics
NPI:1861678930
Name:DIXON CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:DIXON CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEWEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:618-745-6894
Mailing Address - Street 1:426 S BLANCHE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNDS
Mailing Address - State:IL
Mailing Address - Zip Code:62964-1108
Mailing Address - Country:US
Mailing Address - Phone:618-745-6894
Mailing Address - Fax:618-745-6113
Practice Address - Street 1:426 S BLANCHE ST
Practice Address - Street 2:
Practice Address - City:MOUNDS
Practice Address - State:IL
Practice Address - Zip Code:62964-1108
Practice Address - Country:US
Practice Address - Phone:618-745-6894
Practice Address - Fax:618-745-6113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIXON CHIROPRACTIC CENTER, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty