Provider Demographics
NPI:1861569949
Name:DUDLEY, THOMAS H (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:DUDLEY
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 1:2320 S CARSON ST
Mailing Address - Street 2:#3
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-4603
Mailing Address - Country:US
Mailing Address - Phone:775-885-7900
Mailing Address - Fax:775-885-1819
Practice Address - Street 1:2320 S CARSON ST
Practice Address - Street 2:#3
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4603
Practice Address - Country:US
Practice Address - Phone:775-885-7900
Practice Address - Fax:775-885-1819
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV11816OtherBLUE CROSS FEDERAL
NVCC2763OtherBLUE CROSS BLUE SHIELD
NV11816OtherBLUE CROSS FEDERAL