Provider Demographics
NPI:1285719419
Name:DIXON, JOHN RUSSEL (DC, CCN)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RUSSEL
Last Name:DIXON
Suffix:
Gender:M
Credentials:DC, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77570 SPRINGFIELD LN
Mailing Address - Street 2:SUITE E
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0483
Mailing Address - Country:US
Mailing Address - Phone:760-776-0022
Mailing Address - Fax:760-776-8788
Practice Address - Street 1:77570 SPRINGFIELD LN
Practice Address - Street 2:SUITE E
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-0483
Practice Address - Country:US
Practice Address - Phone:760-776-0022
Practice Address - Fax:760-776-8788
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27043111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT60479Medicare UPIN