Provider Demographics
NPI:1548580525
Name:HODDER, AMANDA JANE (DC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:HODDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JANE
Other - Last Name:SPYRATOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:25 MOHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12302-2563
Mailing Address - Country:US
Mailing Address - Phone:518-390-2484
Mailing Address - Fax:518-374-0273
Practice Address - Street 1:25 MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12302-2565
Practice Address - Country:US
Practice Address - Phone:518-390-2484
Practice Address - Fax:518-374-0273
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012008-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300044724OtherPTAN