Provider Demographics
NPI:1235175050
Name:HUDSON, SHAWNA KATHLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:KATHLEEN
Last Name:HUDSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 CORTLANDT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-7063
Mailing Address - Country:US
Mailing Address - Phone:713-862-6008
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7149DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0383119Medicaid
TXU65276Medicare UPIN
TX81051FMedicare PIN