Provider Demographics
NPI:1730204314
Name:HUDSON CHIROPRACTIC INC.
Entity type:Organization
Organization Name:HUDSON CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-748-2252
Mailing Address - Street 1:11075 S STATE ST STE 29
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5144
Mailing Address - Country:US
Mailing Address - Phone:801-748-2252
Mailing Address - Fax:801-990-4301
Practice Address - Street 1:11075 S STATE ST STE 29
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5144
Practice Address - Country:US
Practice Address - Phone:801-748-2252
Practice Address - Fax:801-748-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5730710-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012742Medicare ID - Type Unspecified