Provider Demographics
NPI:1699739573
Name:DIXON, ROGER EUGENE (DC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:EUGENE
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 1:249 BOND SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:MO
Mailing Address - Zip Code:65064-2120
Mailing Address - Country:US
Mailing Address - Phone:573-301-7268
Mailing Address - Fax:
Practice Address - Street 1:105 E NORTH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-1551
Practice Address - Country:US
Practice Address - Phone:573-392-3474
Practice Address - Fax:573-392-3478
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000170551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO666500OtherACN GROUP
MO661928OtherHEALTHLINK
MO189017OtherBLUE CROSS BLUE SHIELD
MO2196256OtherFIRST HEALTH
MOT61776Medicare UPIN