Provider Demographics
NPI:1447244744
Name:DODD, LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
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 1:309-199 W. MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4385
Mailing Address - Country:US
Mailing Address - Phone:919-788-8881
Mailing Address - Fax:919-788-8818
Practice Address - Street 1:309-199 W. MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4385
Practice Address - Country:US
Practice Address - Phone:919-788-8881
Practice Address - Fax:919-788-8818
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0201UOtherGROUP BCBS NUMBER
NC7908316Medicaid
NC08316OtherBCBS INDIVIDUAL NUMBER
NC790201UMedicaid
NC08316OtherBCBS INDIVIDUAL NUMBER
NC0201UOtherGROUP BCBS NUMBER
NCV04803Medicare UPIN