Provider Demographics
NPI:1033289855
Name:HODA, QIRJAKO KIRK (DC)
Entity Type:Individual
Prefix:MR
First Name:QIRJAKO
Middle Name:KIRK
Last Name:HODA
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 1:404 W IRVING PARK ROAD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191
Mailing Address - Country:US
Mailing Address - Phone:630-709-4469
Mailing Address - Fax:630-543-3129
Practice Address - Street 1:404 W IRVING PARK ROAD
Practice Address - Street 2:SUITE #1
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191
Practice Address - Country:US
Practice Address - Phone:630-709-4469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232555OtherBCBS OF IL
V02367Medicare UPIN
IL2232555OtherBCBS OF IL