MEDICARE: DOBSON CHIROPRACTIC, INC.

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

General Provider Information

NPI Number	:	1558962514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOBSON CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	587 5TH ST W
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6831
Country	:	US
Telephone Number	:	707-935-1006
Fax Number	:	707-935-7291

Provider Business Practice Location Address
First Line	:	587 5TH ST W
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6831
Country	:	US
Telephone Number	:	707-935-1006
Fax Number	:	707-935-7291

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GRANT MICHAEL DOBSON
Credential	:	DC
Telephone Number	:	707-935-1006

Provider Enumeration Date	:	11/05/2020
Last Update Date	:	12/02/2020

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