Provider Demographics
NPI:1033103502
Name:DODD, DANIEL A (DC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:DODD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3809
Mailing Address - Country:US
Mailing Address - Phone:904-388-1811
Mailing Address - Fax:904-387-6091
Practice Address - Street 1:2025 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3809
Practice Address - Country:US
Practice Address - Phone:904-388-1811
Practice Address - Fax:904-387-6091
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84671Medicare UPIN
FL88077AMedicare ID - Type Unspecified