Healthcare Provider Details

I. General information

NPI: 1982601696
Provider Name (Legal Business Name): JOSEPH J. HODGES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSEPH JAMES HODGES D.C.

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 MILL BEACH RD. SUITE A
BROOKINGS OR
97415
US

IV. Provider business mailing address

PO BOX 2722
HARBOR OR
97415-0325
US

V. Phone/Fax

Practice location:
  • Phone: 541-469-2722
  • Fax: 541-469-0489
Mailing address:
  • Phone: 541-469-2276
  • Fax: 541-469-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2788
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: