Provider Demographics
NPI:1376683094
Name:DIXON, TYSON LEE (DC)
Entity type:Individual
Prefix:DR
First Name:TYSON
Middle Name:LEE
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 1:117 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-3742
Mailing Address - Country:US
Mailing Address - Phone:570-893-1110
Mailing Address - Fax:570-893-1112
Practice Address - Street 1:117 HIGH ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-3742
Practice Address - Country:US
Practice Address - Phone:570-893-1110
Practice Address - Fax:570-893-1112
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 007056-L111NX0100X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001705879-0003Medicaid
PA977051OtherBCBS OF PA
PA001705879-0003Medicaid
PA977051OtherBCBS OF PA