Provider Demographics
NPI:1578638847
Name:HODGE, ROD (MED,DC)
Entity type:Individual
Prefix:DR
First Name:ROD
Middle Name:
Last Name:HODGE
Suffix:
Gender:M
Credentials:MED,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 SAN PEDRO DR NE STE B-L
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-8900
Mailing Address - Country:US
Mailing Address - Phone:505-878-0046
Mailing Address - Fax:505-878-0052
Practice Address - Street 1:3939 SAN PEDRO DR NE STE B-L
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-8900
Practice Address - Country:US
Practice Address - Phone:505-878-0046
Practice Address - Fax:505-878-0052
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMIKC55OtherBCBS
NMU64225Medicare UPIN