Provider Demographics
NPI:1033153044
Name:HODGES, WAYNE JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:JOSEPH
Last Name:HODGES
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 1:1650 W AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2814
Mailing Address - Country:US
Mailing Address - Phone:661-940-6302
Mailing Address - Fax:661-940-6083
Practice Address - Street 1:44820 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2312
Practice Address - Country:US
Practice Address - Phone:661-940-6302
Practice Address - Fax:661-940-6083
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18037111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC0180370AMedicare UPIN
CAW15783Medicare ID - Type Unspecified