Provider Demographics
NPI:1851450985
Name:HODGE, GARY DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DEAN
Last Name:HODGE
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 1:4097 JAMES STREET RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-7736
Mailing Address - Country:US
Mailing Address - Phone:360-398-1988
Mailing Address - Fax:360-671-6877
Practice Address - Street 1:4097 JAMES STREET RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7736
Practice Address - Country:US
Practice Address - Phone:360-398-1988
Practice Address - Fax:360-671-6877
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA13976OtherMEDE
WA00449OtherREGENCE
WA0152617OtherDEPARTMENT OF L & I
WA81360OtherDEPARTMENT OF L & I
WA13976OtherMEDE
WAGAB23153Medicare ID - Type Unspecified