Provider Demographics
NPI:1154421212
Name:DODES, GLENN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:LEE
Last Name:DODES
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 1:95 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-4006
Mailing Address - Country:US
Mailing Address - Phone:781-575-0100
Mailing Address - Fax:781-821-9964
Practice Address - Street 1:95 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4006
Practice Address - Country:US
Practice Address - Phone:781-575-0100
Practice Address - Fax:781-821-9964
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1871MA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA44-00074OtherUNITED HEALTHCARE
MA2060411OtherAETNA
MA351969OtherHARVARD PILGRIM HEALTH
MA453635OtherTUFTS
MA44-00074OtherUNITED HEALTHCARE
MAU54266Medicare UPIN