Dewey G Dixon Jr., D.C.
Individual provider Active NPI Sports Physician Chiropractor · Mounds, IL
NPI 1215901236 · NPPES record last updated Dec 19, 2014
Key facts
- NPI
- 1215901236
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Physician Chiropractor 111NS0005X
- License
- 38-005019 (IL)
- Practice address
- 426 S Blanche St
Mounds, IL 62964-1108 - Phone
- (618) 745-6894
- Fax
- (618) 745-6113
- NPI assigned
- Feb 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Logan College of Chiropractic, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
426 S Blanche St
Mounds, IL 62964-1108
Phone (618) 745-6894
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080314000276 | IL | Practitioner - Chiropractic | 2466537410 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38-005019 | IL | MD | Sports Physician Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Diversified Rehab Services, LLC | Current | Accepting new patients | |
| Dixon Chiropractic Center, PC | Current |
Accepting new patients |
Locations
426 S Blanche St
Mounds, IL 62964
Phone (618) 745-6894
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 38-005019 | IL | Yes |
Addresses
Primary practice location
426 S Blanche St
Mounds, IL 62964-1108
Mailing address
426 S Blanche St
Mounds, IL 62964-1108
Phone (618) 745-6894
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7782002 | Other | IL | BLUE CROSS BLUE SHIELD |
| 131779 | Other | IL | HEALTHLINK |
Other providers in Mounds, IL
- Shakarra Childress
- County of Pulaski
- Delta Center, Inc
- Diversified Rehab Services, LLC
- Dixon Chiropractic Center, PC
- Gordon D Holden
- Integrated Family Health LLC
- Meridian Cusd #101
- Elly Nelson
All providers in Mounds, IL · Sports Physician Chiropractor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.