Provider Demographics
NPI:1770742942
Name:DODGE, TERI RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:TERI
Middle Name:RENEE
Last Name:DODGE
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:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:LYNDONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05851-0307
Mailing Address - Country:US
Mailing Address - Phone:802-274-2302
Mailing Address - Fax:
Practice Address - Street 1:118 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:EAST BURKE
Practice Address - State:VT
Practice Address - Zip Code:05832-9998
Practice Address - Country:US
Practice Address - Phone:802-274-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060001202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor