Healthcare Provider Details

I. General information

NPI: 1477599306
Provider Name (Legal Business Name): CLINTON S DODGE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 02/01/2020
Certification Date: 02/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 CENTRAL AVE
BATESVILLE IN
47006-8917
US

IV. Provider business mailing address

8902 N MERIDIAN ST STE 101
INDIANAPOLIS IN
46260-5306
US

V. Phone/Fax

Practice location:
  • Phone: 812-932-3999
  • Fax: 812-932-3998
Mailing address:
  • Phone: 317-848-8048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002136A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: