Healthcare Provider Details

I. General information

NPI: 1902532203
Provider Name (Legal Business Name): KENYA M HODGES DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 W CAREFREE CIR STE 2
COLORADO SPRINGS CO
80917-3004
US

IV. Provider business mailing address

4070 LACY LN APT 27
COLORADO SPRINGS CO
80916-7324
US

V. Phone/Fax

Practice location:
  • Phone: 720-232-1528
  • Fax:
Mailing address:
  • Phone: 720-232-1528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHR.0007682
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: