Provider Demographics
NPI:1821428954
Name:HODGES, JESSE ROBERT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ROBERT
Last Name:HODGES
Suffix:JR
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 1:12000 CAROLINES CV APT 205B
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1131
Mailing Address - Country:US
Mailing Address - Phone:504-669-2815
Mailing Address - Fax:
Practice Address - Street 1:1780 S NOVA RD STE 4
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119
Practice Address - Country:US
Practice Address - Phone:386-679-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12421111NS0005X
FL1687111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician