Provider Demographics
NPI:1831524503
Name:DODGE, MICHELLE GAEBEL (DC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GAEBEL
Last Name:DODGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:WALSEMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:8479 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SODUS
Mailing Address - State:NY
Mailing Address - Zip Code:14551-9569
Mailing Address - Country:US
Mailing Address - Phone:315-498-0243
Mailing Address - Fax:315-498-0249
Practice Address - Street 1:8479 RIDGE RD
Practice Address - Street 2:
Practice Address - City:SODUS
Practice Address - State:NY
Practice Address - Zip Code:14551-9569
Practice Address - Country:US
Practice Address - Phone:315-498-0243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor