Provider Demographics
NPI:1619317443
Name:HODES CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HODES CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HODES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-754-2300
Mailing Address - Street 1:1249 W MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3100
Mailing Address - Country:US
Mailing Address - Phone:203-754-2300
Mailing Address - Fax:203-754-2301
Practice Address - Street 1:1249 W MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3100
Practice Address - Country:US
Practice Address - Phone:203-754-2300
Practice Address - Fax:203-754-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1912964826OtherNPI
CT2113832OtherAETNA
CTNHS467OtherOXFORD
CT000001470878OtherPRIVATE HEALTHCARE SYSTEM
CT050000899CT02OtherANTHEM BLUE CROSS
CT4298598OtherAETNA
CT745717OtherCONNECTICARE
CT050000899CT04OtherBLUE CROSS BLUE SHIELD
CT71314OtherAMERICAN SPECIALTY
CT742701OtherCONNECTICARE
CT742701OtherCONNECTICARE