Provider Demographics
NPI:1891880795
Name:DIXON, GREG NOLAND (DC)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:NOLAND
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 1:5700 MARKET ST
Mailing Address - Street 2:APT 1054
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-6512
Mailing Address - Country:US
Mailing Address - Phone:928-460-3305
Mailing Address - Fax:
Practice Address - Street 1:5700 MARKET ST
Practice Address - Street 2:APT 1054
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-6512
Practice Address - Country:US
Practice Address - Phone:928-460-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU83156Medicare UPIN