Healthcare Provider Details

I. General information

NPI: 1285719419
Provider Name (Legal Business Name): JOHN RUSSEL DIXON D.C., CCN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77570 SPRINGFIELD LN SUITE E
PALM DESERT CA
92211-0483
US

IV. Provider business mailing address

77570 SPRINGFIELD LN SUITE E
PALM DESERT CA
92211-0483
US

V. Phone/Fax

Practice location:
  • Phone: 760-776-0022
  • Fax: 760-776-8788
Mailing address:
  • Phone: 760-776-0022
  • Fax: 760-776-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number27043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: