Provider Demographics
NPI:1396710398
Name:DODDS, RICHARD MARK (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARK
Last Name:DODDS
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 1:2617 UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001
Mailing Address - Country:US
Mailing Address - Phone:563-588-8050
Mailing Address - Fax:563-589-0027
Practice Address - Street 1:2617 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-5560
Practice Address - Country:US
Practice Address - Phone:563-588-8050
Practice Address - Fax:563-589-0027
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAT01280Medicare UPIN
IAI1938Medicare ID - Type Unspecified