MEDICARE: DR. LAURIE LEIGH DODIE-SWOVERLAND D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	AZ3966	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	623158	OTHER	AZ	ACN GROUP
2	AZ0245620	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1245296193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE LEIGH DODIE-SWOVERLAND D.C.

Provider Business Mailing Address
First Line	:	3920 E INDIAN SCHOOL RD
Second Line	:	SUITE 16
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5257
Country	:	US
Telephone Number	:	602-956-3360
Fax Number	:	602-977-1357

Provider Business Practice Location Address
First Line	:	3920 E INDIAN SCHOOL RD
Second Line	:	SUITE 16
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5257
Country	:	US
Telephone Number	:	602-956-3360
Fax Number	:	602-977-1357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	11/10/2014

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