MEDICARE: LARRY A DIXON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	04180	IA

General Provider Information

NPI Number	:	1245225408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY A DIXON DC

Provider Business Mailing Address
First Line	:	2007 18TH ST
Second Line	:	SUITE 1
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-1073
Country	:	US
Telephone Number	:	712-336-1365
Fax Number	:	712-336-0924

Provider Business Practice Location Address
First Line	:	2007 18TH ST
Second Line	:	SUITE 1
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-1073
Country	:	US
Telephone Number	:	712-336-1365
Fax Number	:	712-336-0924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	09/04/2012

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