Provider Demographics
NPI:1700966645
Name:HODGE, DERMAN BYERLY III (DC)
Entity Type:Individual
Prefix:DR
First Name:DERMAN
Middle Name:BYERLY
Last Name:HODGE
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2711 FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6461
Mailing Address - Country:US
Mailing Address - Phone:843-407-8657
Mailing Address - Fax:843-661-7906
Practice Address - Street 1:2631 LAURENS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3817
Practice Address - Country:US
Practice Address - Phone:864-297-0640
Practice Address - Fax:843-661-7906
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor