Provider Demographics
NPI:1063492403
Name:HODGE, LEE W (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:W
Last Name:HODGE
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 1600
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-1600
Mailing Address - Country:US
Mailing Address - Phone:501-329-2774
Mailing Address - Fax:
Practice Address - Street 1:797 TEAL DRIVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8002
Practice Address - Country:US
Practice Address - Phone:501-329-2774
Practice Address - Fax:501-327-0907
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR18895000040OtherQUAL CHOICE OF ARKANSAS
AR2459961OtherCIGNA
AR721190OtherAETNA
ARS02725OtherNOVA SYSTEMS
AR5T646OtherBLUE CROSS BLUE SHIELD
AR44-20060OtherUNITED HEALTH CARE
AR710847827OtherPIN
AR2459961OtherCIGNA
ARS02725OtherNOVA SYSTEMS
AR5T646Medicare ID - Type Unspecified
AR5G834Medicare PIN