Provider Demographics
NPI:1780747949
Name:HIXON, GREG A (DC)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:A
Last Name:HIXON
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 1:1108 N BECHTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2010
Mailing Address - Country:US
Mailing Address - Phone:937-328-3220
Mailing Address - Fax:937-328-3222
Practice Address - Street 1:1108 N BECHTLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2010
Practice Address - Country:US
Practice Address - Phone:937-328-3220
Practice Address - Fax:937-328-3222
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000022636OtherANTHEM PIN
OH0964685Medicaid
OH311584234OtherTAX ID
OHU46156Medicare UPIN
OH311584234OtherTAX ID