Provider Demographics
NPI:1235671132
Name:FORD, DAWN (DC)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:
Last Name:FORD
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 1:20 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6840
Mailing Address - Country:US
Mailing Address - Phone:802-343-3900
Mailing Address - Fax:
Practice Address - Street 1:20 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6840
Practice Address - Country:US
Practice Address - Phone:802-343-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0047438111N00000X
NYX004929-1111N00000X
MO005214111N00000X
IL38-005529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor