Provider Demographics
NPI:1811992118
Name:DODSON-HARDEMAN, DIA GAYBRIELLE (DC)
Entity type:Individual
Prefix:DR
First Name:DIA
Middle Name:GAYBRIELLE
Last Name:DODSON-HARDEMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DIA
Other - Middle Name:GAYBRIELLE
Other - Last Name:DODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:311 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-1709
Mailing Address - Country:US
Mailing Address - Phone:903-856-7771
Mailing Address - Fax:903-856-7772
Practice Address - Street 1:311 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-1709
Practice Address - Country:US
Practice Address - Phone:903-856-7771
Practice Address - Fax:903-856-7772
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU96297Medicare UPIN
TX00579VMedicare ID - Type Unspecified