1720310857 NPI number — DR. ELIZABETH L NIXON D.C.

Table of content: DR. ELIZABETH L NIXON D.C. (NPI 1720310857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720310857 NPI number — DR. ELIZABETH L NIXON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIXON
Provider First Name:
ELIZABETH
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EVANS
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720310857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
546 E FM 2410 RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARKER HEIGHTS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76548-5692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-681-1544
Provider Business Mailing Address Fax Number:
877-229-7069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
546 E FM 2410 RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARKER HEIGHTS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76548-5692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-681-1544
Provider Business Practice Location Address Fax Number:
877-229-7069
Provider Enumeration Date:
01/29/2010

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: 111N00000X , with the licence number:  11369 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 608798 . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 292326 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".