1699739573 NPI number — ROGER EUGENE DIXON D.C.

Table of content: ROGER EUGENE DIXON D.C. (NPI 1699739573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699739573 NPI number — ROGER EUGENE DIXON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXON
Provider First Name:
ROGER
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1699739573
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
249 BOND SCHOOL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLEAN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65064-2120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-301-7268
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 E NORTH ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
ELDON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65026-1551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-392-3474
Provider Business Practice Location Address Fax Number:
573-392-3478
Provider Enumeration Date:
04/17/2006

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:  2000170551 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 666500 . This is a "ACN GROUP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 661928 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 189017 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2196256 . This is a "FIRST HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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