Provider Demographics
NPI:1700903846
Name:DIXON CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:DIXON CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-535-7507
Mailing Address - Street 1:420 N US 31
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1463
Mailing Address - Country:US
Mailing Address - Phone:317-535-7507
Mailing Address - Fax:317-535-7583
Practice Address - Street 1:420 N US 31
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1463
Practice Address - Country:US
Practice Address - Phone:317-535-7507
Practice Address - Fax:317-535-7583
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIXON CHIROPRACTIC CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-23
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001653A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200082230Medicaid
IN200082230Medicaid