Healthcare Provider Details

I. General information

NPI: 1356314942
Provider Name (Legal Business Name): JEANNE MARY DIXON DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200A SCHOOL OF MINES ROAD
SOCORRO NM
87801
US

IV. Provider business mailing address

PO BOX 233
SOCORRO NM
87801-0233
US

V. Phone/Fax

Practice location:
  • Phone: 505-835-4787
  • Fax:
Mailing address:
  • Phone: 505-835-4787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number697
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: