1164514022 NPI number — RUTH ELIZABETH DIXON DC

Table of content: RUTH ELIZABETH DIXON DC (NPI 1164514022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164514022 NPI number — RUTH ELIZABETH DIXON DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXON
Provider First Name:
RUTH
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUNNING
Provider Other First Name:
RUSH
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164514022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 N RICHMOND ST
Provider Second Line Business Mailing Address:
RUTH E DIXON DC
Provider Business Mailing Address City Name:
APPLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-731-0599
Provider Business Mailing Address Fax Number:
920-731-0599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 N RICHMOND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLETON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-731-0599
Provider Business Practice Location Address Fax Number:
920-731-0599
Provider Enumeration Date:
09/29/2006

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:  2916 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38869200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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