Healthcare Provider Details

I. General information

NPI: 1801927892
Provider Name (Legal Business Name): WAYNE J HODGES CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W AVENUE J
LANCASTER CA
93534-2814
US

IV. Provider business mailing address

1650 W AVENUE J
LANCASTER CA
93534-2814
US

V. Phone/Fax

Practice location:
  • Phone: 661-940-6302
  • Fax: 661-940-6083
Mailing address:
  • Phone: 661-940-6302
  • Fax: 661-940-6083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC18037
License Number StateCA

VIII. Authorized Official

Name: MISS SARA R FLOREZ
Title or Position: OFFICE BILLER CREDENTIALER
Credential:
Phone: 661-940-6302