Provider Demographics
NPI:1295860443
Name:HUDAK CHIROPRACTIC & WELLNESS CENTER PC
Entity Type:Organization
Organization Name:HUDAK CHIROPRACTIC & WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HUDAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-651-2522
Mailing Address - Street 1:PO BOX 8157
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29578-8157
Mailing Address - Country:US
Mailing Address - Phone:843-651-2522
Mailing Address - Fax:843-651-2499
Practice Address - Street 1:920 MOUNT GILEAD RD
Practice Address - Street 2:SUITE C-1
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7791
Practice Address - Country:US
Practice Address - Phone:843-651-2522
Practice Address - Fax:843-651-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty