Provider Demographics
NPI:1720208960
Name:DODSON, KAREN LYNN (LAC CH DOM)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:DODSON
Suffix:
Gender:F
Credentials:LAC CH DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11809 US HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-5000
Mailing Address - Country:US
Mailing Address - Phone:608-346-0471
Mailing Address - Fax:
Practice Address - Street 1:4873 MANHATTAN DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2265
Practice Address - Country:US
Practice Address - Phone:815-977-5876
Practice Address - Fax:855-509-0419
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI197055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist