Provider Demographics
NPI:1437236650
Name:KUDRICK, JOHN W (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:KUDRICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11945 GRANDHAVEN DR STE F
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-8091
Mailing Address - Country:US
Mailing Address - Phone:843-357-7200
Mailing Address - Fax:843-357-7203
Practice Address - Street 1:11945 GRANDHAVEN DR STE F
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-8091
Practice Address - Country:US
Practice Address - Phone:843-357-7200
Practice Address - Fax:843-357-7203
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00476800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U72540Medicare UPIN
020914Medicare ID - Type Unspecified