Provider Demographics
NPI:1023217924
Name:HUDSON CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:HUDSON CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-386-6100
Mailing Address - Street 1:1810 WEBSTER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-9305
Mailing Address - Country:US
Mailing Address - Phone:715-386-6100
Mailing Address - Fax:
Practice Address - Street 1:1810 WEBSTER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9305
Practice Address - Country:US
Practice Address - Phone:715-386-6100
Practice Address - Fax:715-386-6298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN045N7HUOtherBLUE CLOSS AND BLUE SHIELD OF MINNESOTA
WI=========015OtherBLUE CROSS AND BLUE SHIELD OF WISCONSIN
MN045N7HUOtherBLUE CLOSS AND BLUE SHIELD OF MINNESOTA