Provider Demographics
NPI:1912964826
Name:HODES, SCOTT A (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:HODES
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 1:1249 W MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3100
Mailing Address - Country:US
Mailing Address - Phone:203-754-2300
Mailing Address - Fax:206-754-2301
Practice Address - Street 1:1249 W MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3100
Practice Address - Country:US
Practice Address - Phone:203-754-2300
Practice Address - Fax:203-754-2301
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000899OtherLANDMARK
CT745717OtherCONNECTICARE
CTNHS467OtherOXFORD
CT050000899CT02OtherANTHEM BLUE CROSS
CT742701OtherCONNECTICARE
CT350001020OtherMEDICARE
CT050000899CT04OtherBLUE CROSS BLUE SHIELD
CT1497921449OtherNPI
CT4298598OtherAETNA
CT000001470878OtherPRIVATE HEALTHCARE SYSTEM
CT2113832OtherAETNA
CT71314OtherAMERICAN SPECIALTY
CT4298598OtherAETNA
CT71314OtherAMERICAN SPECIALTY