Provider Demographics
NPI:1619187309
Name:HODGSON, TINA CHERYL (DC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:CHERYL
Last Name:HODGSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-3515
Mailing Address - Country:US
Mailing Address - Phone:717-292-0468
Mailing Address - Fax:
Practice Address - Street 1:56 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-1509
Practice Address - Country:US
Practice Address - Phone:717-292-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007405-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA995143OtherBC & BS ID NUMBER
PA995143OtherBC & BS ID NUMBER