Provider Demographics
NPI:1043761851
Name:DIXON, JONATHAN EDWARD (ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:EDWARD
Last Name:DIXON
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 POLARIS PKWY
Mailing Address - Street 2:APPT. 438
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-2256
Mailing Address - Country:US
Mailing Address - Phone:757-642-2442
Mailing Address - Fax:
Practice Address - Street 1:3168 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43221-2540
Practice Address - Country:US
Practice Address - Phone:614-488-2994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20000198492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer