Provider Demographics
NPI:1003910530
Name:HUDSON CHIROPRACTIC
Entity Type:Organization
Organization Name:HUDSON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIRPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-290-1905
Mailing Address - Street 1:1820-1 W 43RD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-3006
Mailing Address - Country:US
Mailing Address - Phone:713-290-1905
Mailing Address - Fax:713-290-8322
Practice Address - Street 1:1820-1 W 43RD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-3006
Practice Address - Country:US
Practice Address - Phone:713-290-1905
Practice Address - Fax:713-290-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7149DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0383119Medicaid
TX81051FMedicare PIN
TX0383119Medicaid