Individual
JEANETTE ELIZABETH DODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
10900 SW NORTH DAKOTA ST, TIGARD, OR 97223-4121
(503) 968-3124
Mailing address
11575 SW PACIFIC HWY STE 147, TIGARD, OR 97223-8671
(503) 968-3124
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC00121
OR
Other
Enumeration date
02/13/2009
Last updated
02/13/2009
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