Provider Demographics
NPI:1811261597
Name:DODSON, TYANNA CHANTEL (DC)
Entity type:Individual
Prefix:DR
First Name:TYANNA
Middle Name:CHANTEL
Last Name:DODSON
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 1:5175 DORMAN ST # A
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-5703
Mailing Address - Country:US
Mailing Address - Phone:989-954-0310
Mailing Address - Fax:
Practice Address - Street 1:1919 S SHILOH RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-8234
Practice Address - Country:US
Practice Address - Phone:972-840-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor