Provider Demographics
NPI:1093828808
Name:DUDYCHA, JUSTIN D (DC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:D
Last Name:DUDYCHA
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 1:8228 BANDERA
Mailing Address - Street 2:
Mailing Address - City:SA
Mailing Address - State:TX
Mailing Address - Zip Code:78250
Mailing Address - Country:US
Mailing Address - Phone:210-681-8200
Mailing Address - Fax:210-521-0919
Practice Address - Street 1:8228 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250
Practice Address - Country:US
Practice Address - Phone:210-681-8200
Practice Address - Fax:210-681-0919
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC10132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V08057Medicare UPIN
8G3262Medicare ID - Type Unspecified