Provider Demographics
NPI:1215901236
Name:DIXON, DEWEY G JR (DC)
Entity type:Individual
Prefix:DR
First Name:DEWEY
Middle Name:G
Last Name:DIXON
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 S BLANCHE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNDS
Mailing Address - State:IL
Mailing Address - Zip Code:62964-1108
Mailing Address - Country:US
Mailing Address - Phone:618-745-6894
Mailing Address - Fax:
Practice Address - Street 1:426 S BLANCHE ST
Practice Address - Street 2:
Practice Address - City:MOUNDS
Practice Address - State:IL
Practice Address - Zip Code:62964-1108
Practice Address - Country:US
Practice Address - Phone:618-745-6894
Practice Address - Fax:618-745-6113
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38-005019111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7782002OtherBLUE CROSS BLUE SHIELD
IL131779OtherHEALTHLINK
IL200907Medicare ID - Type Unspecified
IL7782002OtherBLUE CROSS BLUE SHIELD