Provider Demographics
NPI:1780935171
Name:DODGE, ANDREW DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DAVID
Last Name:DODGE
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 1:1600 N COALTER ST
Mailing Address - Street 2:SUITE 303A
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2551
Mailing Address - Country:US
Mailing Address - Phone:540-885-1735
Mailing Address - Fax:540-885-1736
Practice Address - Street 1:1600 N COALTER ST
Practice Address - Street 2:SUITE 303A
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2551
Practice Address - Country:US
Practice Address - Phone:540-885-1735
Practice Address - Fax:540-885-1736
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor