Provider Demographics
NPI:1760134118
Name:HODGE, KYLE ROBERT (DC, ATC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ROBERT
Last Name:HODGE
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 S HOLMESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-9647
Mailing Address - Country:US
Mailing Address - Phone:219-252-1029
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:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003277A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor