Provider Demographics
NPI:1093801342
Name:LEE W. HODGE D.C. P.A.
Entity Type:Organization
Organization Name:LEE W. HODGE D.C. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:W
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-329-2774
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 1:1214 HOGAN LN
Practice Address - Street 2:STE 200
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR44-20060OtherUNITED HEALTH CARE
AR5T646OtherBLUE ADVANTAGE
GAP00228479OtherMEDICARE (RAILROAD)
AR5T646OtherBLUE CROSS BLUE SHEILD
AR18895000040OtherQCA
AR5T646OtherHEALTH ADVANTAGE
ARS02725OtherNOVA SYSTEMS
AR7211190OtherAETNA
AR18895000040OtherQCA
GAP00228479OtherMEDICARE (RAILROAD)
ARU67326Medicare UPIN