Provider Demographics
NPI:1407587876
Name:LODGE CHIROPRACTIC
Entity Type:Organization
Organization Name:LODGE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-681-2220
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty