MEDICARE: DR. JAMES DODGE 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	DC27418	CA

General Provider Information

NPI Number	:	1548267289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DODGE D.C.

Provider Business Mailing Address
First Line	:	2111 W KETTLEMAN LN
Second Line	:	SUITE C
City	:	LODI
State	:	CA
Zip	:	95242-4336
Country	:	US
Telephone Number	:	209-366-1234
Fax Number	:	209-366-1236

Provider Business Practice Location Address
First Line	:	2111 W KETTLEMAN LN
Second Line	:	SUITE C
City	:	LODI
State	:	CA
Zip	:	95242-4336
Country	:	US
Telephone Number	:	209-366-1234
Fax Number	:	209-366-1236

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. JAMES DODGE D.C.” Practice Location

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