Provider Demographics
NPI:1316978273
Name:DIXON, ROBERT WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:DIXON
Suffix:
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 1:420 N US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1463
Mailing Address - Country:US
Mailing Address - Phone:317-535-7507
Mailing Address - Fax:317-535-7583
Practice Address - Street 1:420 N US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1463
Practice Address - Country:US
Practice Address - Phone:317-535-7507
Practice Address - Fax:317-535-7583
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001653A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN351977956OtherSAGAMORE
IN200082230AMedicaid
IN351977956OtherSHIO
IN000000091407OtherANTHEM
IN351977956OtherAETNA
IN351977956OtherHUMANA
IN351977956OtherKEY BENEFIT
IN351977956OtherRURAL CARRIER
IN351977956OtherMAIL HANDLERS
IN200082230AMedicaid