Provider Demographics
NPI:1295971877
Name:DIXON CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:DIXON CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEWEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:618-745-6894
Mailing Address - Street 1:2230 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63780-1329
Mailing Address - Country:US
Mailing Address - Phone:573-264-1999
Mailing Address - Fax:573-264-1998
Practice Address - Street 1:2230 MAIN ST
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:MO
Practice Address - Zip Code:63780-1329
Practice Address - Country:US
Practice Address - Phone:573-264-1999
Practice Address - Fax:573-264-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008036327111N00000X
MO2008037275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty