MEDICARE: DR. JOHN PAUL HODGES JR. D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN1001X	Nutrition Chiropractor	4141	TX

General Provider Information

NPI Number	:	1285634014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PAUL HODGES JR. D.C.

Provider Business Mailing Address
First Line	:	PO BOX 1688
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77574-1688
Country	:	US
Telephone Number	:	281-332-9631
Fax Number	:	281-332-8192

Provider Business Practice Location Address
First Line	:	2047 W MAIN ST
Second Line	:	SUITE A8
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3579
Country	:	US
Telephone Number	:	281-332-9631
Fax Number	:	281-332-8192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	01/07/2008

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