Healthcare Provider Details

I. General information

NPI: 1043296726
Provider Name (Legal Business Name): BRIAN SCOTT DIXON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BERKSHIRE AVE
SPRINGFIELD MA
01109-1709
US

IV. Provider business mailing address

90 BERKSHIRE AVE
SPRINGFIELD MA
01109-1709
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-7968
  • Fax: 413-788-0194
Mailing address:
  • Phone: 413-596-9874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1038
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: