MEDICARE: DIXON CHIROPRACTIC, LLC

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	2008036327	MO
2	111N00000X	Chiropractor	2008037275	MO

General Provider Information

NPI Number	:	1295971877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIXON CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	2230 MAIN ST
Second Line	:
City	:	SCOTT CITY
State	:	MO
Zip	:	63780-1329
Country	:	US
Telephone Number	:	573-264-1999
Fax Number	:	573-264-1998

Provider Business Practice Location Address
First Line	:	2230 MAIN ST
Second Line	:
City	:	SCOTT CITY
State	:	MO
Zip	:	63780-1329
Country	:	US
Telephone Number	:	573-264-1999
Fax Number	:	573-264-1998

Authorized Official
Title or Position	:	OWNER
Name	:	DEWEY G. DIXON JR.
Credential	:	D.C.
Telephone Number	:	618-745-6894

Provider Enumeration Date	:	01/02/2009
Last Update Date	:	01/02/2009

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