MEDICARE: MATTHEW NIXON, INC

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	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1457589624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW NIXON, INC

Provider Business Mailing Address
First Line	:	13240 N CLEVELAND AVE
Second Line	:	SUITE 9
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-4855
Country	:	US
Telephone Number	:	239-656-3400
Fax Number	:	239-656-3401

Provider Business Practice Location Address
First Line	:	13240 N CLEVELAND AVE
Second Line	:	SUITE 9
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-4855
Country	:	US
Telephone Number	:	239-656-3400
Fax Number	:	239-656-3401

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW BRYAN NIXON
Credential	:	D.C.
Telephone Number	:	239-656-3400

Provider Enumeration Date	:	06/26/2009
Last Update Date	:	06/26/2009

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