MEDICARE: DR TREV DIXON, D.C., P.A

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	DC5746	TX

General Provider Information

NPI Number	:	1619156932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR TREV DIXON, D.C., P.A

Provider Business Mailing Address
First Line	:	211 S ELM ST
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4418
Country	:	US
Telephone Number	:	817-613-1301
Fax Number	:	817-613-1163

Provider Business Practice Location Address
First Line	:	211 S ELM ST
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4418
Country	:	US
Telephone Number	:	817-613-1301
Fax Number	:	817-613-1163

Authorized Official
Title or Position	:	OFFICE MGR
Name	:	JILL BAILEY
Credential	:
Telephone Number	:	817-613-1301

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	11/02/2007

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