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General NPI Number Information
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NPI Number | 1144686247
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Entity Type | Organization
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Legal Business Name | DIXON CHIROPRACTIC P.A.
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Dates
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Enumeration Date | 01/06/2016
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 140 PAUL BUNYAN DR NW
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City | BEMIDJI
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State | MN
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Zip | 56601-2440
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Country | US
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Telephone | 218-751-5910
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Fax |
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Provider Business Mailing Address
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Address Line | 140 PAUL BUNYAN DR NW
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City | BEMIDJI
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State | MN
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Zip | 56601-2440
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Country | US
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Telephone | 218-751-5910
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC/OWNER
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Name | JASON WADE DIXON
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Credential | DC
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Telephone | 218-444-8540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1542
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License Number State | MN
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