Provider Demographics
NPI:1093117236
Name:HUDSON CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:HUDSON CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC,CCSP
Authorized Official - Phone:330-650-0322
Mailing Address - Street 1:46 RAVENNA ST
Mailing Address - Street 2:SUITE A - 4
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3033
Mailing Address - Country:US
Mailing Address - Phone:330-650-0322
Mailing Address - Fax:330-650-0327
Practice Address - Street 1:46 RAVENNA ST
Practice Address - Street 2:SUITE A - 4
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-3033
Practice Address - Country:US
Practice Address - Phone:330-650-0322
Practice Address - Fax:330-650-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4367111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty