1386764108 NPI number — MR. CHRISTOPHER THAD DIXON RPH

Table of content: MR. CHRISTOPHER THAD DIXON RPH (NPI 1386764108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386764108 NPI number — MR. CHRISTOPHER THAD DIXON RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXON
Provider First Name:
CHRISTOPHER
Provider Middle Name:
THAD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386764108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4809 WOODBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BERN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28562-5414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-633-3143
Provider Business Mailing Address Fax Number:
910-298-3091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 CROSSOVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEULAVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28518-8800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-298-3093
Provider Business Practice Location Address Fax Number:
910-298-3091
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  8580 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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