Provider Demographics
NPI:1003959081
Name:HUGHES, RENDON JESS (DC)
Entity Type:Individual
Prefix:
First Name:RENDON
Middle Name:JESS
Last Name:HUGHES
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:PO BOX 1173
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:UT
Mailing Address - Zip Code:84624-1173
Mailing Address - Country:US
Mailing Address - Phone:435-864-1833
Mailing Address - Fax:
Practice Address - Street 1:60 SOUTH 300 EAST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-1173
Practice Address - Country:US
Practice Address - Phone:435-864-1833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT294407-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU57166Medicare UPIN