Provider Demographics
NPI:1245296193
Name:DODIE-SWOVERLAND, LAURIE LEIGH (DC)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:LEIGH
Last Name:DODIE-SWOVERLAND
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 1:3920 E INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5257
Mailing Address - Country:US
Mailing Address - Phone:602-956-3360
Mailing Address - Fax:602-977-1357
Practice Address - Street 1:3920 E INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 16
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5257
Practice Address - Country:US
Practice Address - Phone:602-956-3360
Practice Address - Fax:602-977-1357
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ3966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ623158OtherACN GROUP
AZAZ0245620OtherBLUE CROSS BLUE SHIELD
AZAZ3966Medicare UPIN
AZ66545Medicare ID - Type UnspecifiedGROUP
AZ66546Medicare ID - Type UnspecifiedINDIVIDUAL