MEDICARE: KAREN LYNN DODSON LAC CH DOM

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	171100000X	Acupuncturist	197055	WI

General Provider Information

NPI Number	:	1720208960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LYNN DODSON LAC CH DOM

Provider Business Mailing Address
First Line	:	11809 US HIGHWAY 20
Second Line	:
City	:	HAMPSHIRE
State	:	IL
Zip	:	60140-5000
Country	:	US
Telephone Number	:	608-346-0471
Fax Number	:

Provider Business Practice Location Address
First Line	:	4873 MANHATTAN DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2265
Country	:	US
Telephone Number	:	815-977-5876
Fax Number	:	855-509-0419

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

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	06/08/2023

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