Healthcare Provider Details

I. General information

NPI: 1033153044
Provider Name (Legal Business Name): WAYNE JOSEPH HODGES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44820 10TH ST W
LANCASTER CA
93534-2312
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 Code111NN1001X
TaxonomyNutrition Chiropractor
License Number18037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: