Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 3029 | TX |
NPI | 1316064900 |
---|---|
Provider Name | Dr. Lyle Martin Hodge |
First Address | Duncanville, TX 75137-4423 |
Second Address | Duncanville, TX 75137-4423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 01/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012650-01 | (05) | TX |
T13859 | (02) | TX |