Provider Demographics
NPI:1801927892
Name:WAYNE J HODGES CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:WAYNE J HODGES CHIROPRACTIC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE BILLER CREDENTIALER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:FLOREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-940-6302
Mailing Address - Street 1:1650 W AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2814
Mailing Address - Country:US
Mailing Address - Phone:661-940-6302
Mailing Address - Fax:661-940-6083
Practice Address - Street 1:1650 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2814
Practice Address - Country:US
Practice Address - Phone:661-940-6302
Practice Address - Fax:661-940-6083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT06615Medicare UPIN