Provider Demographics
NPI:1629101902
Name:HOFFERTH, JOSEPH GERARD (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GERARD
Last Name:HOFFERTH
Suffix:
Gender:M
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:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-9230
Mailing Address - Country:US
Mailing Address - Phone:219-763-8112
Mailing Address - Fax:219-764-5333
Practice Address - Street 1:1828 165TH ST STE A
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-2823
Practice Address - Country:US
Practice Address - Phone:219-763-8112
Practice Address - Fax:219-844-9006
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300046583Medicaid
IN191360058OtherMEDICARE PTAN
35198714900OtherCARESOURCE
90000752OtherBCBS OF IL
IN234906OtherHARMONY HEALTH PLAN
2732113OtherAETNA HMO
90000752OtherBCBS OF IL
873300AMedicare ID - Type UnspecifiedMCR