MEDICARE: DR. TREV A DIXON D.C.

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	5746	TX

General Provider Information

NPI Number	:	1639176274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREV A DIXON D.C.

Provider Business Mailing Address
First Line	:	211 SOUTH ELM
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086
Country	:	US
Telephone Number	:	817-599-3092
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	:	817-599-3092
Fax Number	:	817-613-1163

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	11/02/2007

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