Provider Demographics
NPI:1073554192
Name:LODGE, DONNA (DC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:LODGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W FIR ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3284
Mailing Address - Country:US
Mailing Address - Phone:360-681-2220
Mailing Address - Fax:360-681-5267
Practice Address - Street 1:530 W FIR ST STE 1A
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3284
Practice Address - Country:US
Practice Address - Phone:360-681-2220
Practice Address - Fax:360-681-5267
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038008541Medicaid
ILP00173887OtherMEDICARE RAILROAD
IL042965OtherHEALTH ALLIANCE
IL285586OtherPERSONAL CARE
IL09822654OtherBLUE CROSS BLUE SHIELD
IL042965OtherHEALTH ALLIANCE
IL521960Medicare ID - Type Unspecified