Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 38MC00755000 | NJ |
NPI | 1326603168 |
---|---|
Provider Name | Dr. Brett Kevin Hodshon |
First Address | Boonton, NJ 07005-8806 |
Second Address | Boonton, NJ 07005-8806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2019 |
Last Update Date | 07/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38MC00755000 | (05) | NJ |