Provider Demographics
NPI:1497590392
Name:HODGE, JAVARIUS SHANTAVIUS (DC)
Entity type:Individual
Prefix:DR
First Name:JAVARIUS
Middle Name:SHANTAVIUS
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 1:8008 PERRY ST APT 198
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4761
Mailing Address - Country:US
Mailing Address - Phone:913-428-0204
Mailing Address - Fax:
Practice Address - Street 1:933 MCGEE ST UNIT 217
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64106-2208
Practice Address - Country:US
Practice Address - Phone:913-428-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024025772111N00000X, 111NI0900X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty