Provider Demographics
NPI:1902963044
Name:DIX, CYNTHIA (DC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:DIX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 CORDELL CT
Mailing Address - Street 2:STE 104
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-0901
Mailing Address - Country:US
Mailing Address - Phone:619-402-7494
Mailing Address - Fax:
Practice Address - Street 1:1955 CORDELL CT
Practice Address - Street 2:STE 104
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-0901
Practice Address - Country:US
Practice Address - Phone:619-402-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23791111NN1001X
OH2357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9341081OtherGROUP MCR PIN
OH0459286Medicaid
OHY02370Medicare UPIN
OH9341081OtherGROUP MCR PIN