Provider Demographics
NPI:1619624665
Name:HODGE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HODGE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-252-1029
Mailing Address - Street 1:15 FRANKLIN ST STE 120B
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4877
Mailing Address - Country:US
Mailing Address - Phone:219-351-0808
Mailing Address - Fax:
Practice Address - Street 1:15 FRANKLIN ST STE 120B
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4877
Practice Address - Country:US
Practice Address - Phone:219-351-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty