Provider Demographics
NPI:1639199318
Name:DIXON, PATRICK J (DC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
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:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-0428
Mailing Address - Country:US
Mailing Address - Phone:408-460-6636
Mailing Address - Fax:
Practice Address - Street 1:1605 FRED W MOORE HWY
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-5296
Practice Address - Country:US
Practice Address - Phone:810-329-6100
Practice Address - Fax:810-329-8650
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor