Provider Demographics
NPI:1104967264
Name:SPINE CARE INSTITUTE CLEAR LAKE
Entity type:Organization
Organization Name:SPINE CARE INSTITUTE CLEAR LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:281-332-9631
Mailing Address - Street 1:2047 W MAIN ST
Mailing Address - Street 2:SUITE A8
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3579
Mailing Address - Country:US
Mailing Address - Phone:281-332-9631
Mailing Address - Fax:281-332-8192
Practice Address - Street 1:2047 W MAIN ST
Practice Address - Street 2:SUITE A8
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3579
Practice Address - Country:US
Practice Address - Phone:281-332-9631
Practice Address - Fax:281-332-8192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4141111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty