Provider Demographics
NPI:1346272291
Name:HUDSON, VERONICA L (DC)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:L
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 1:150 S HWY 69
Mailing Address - Street 2:STE 7
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-9502
Mailing Address - Country:US
Mailing Address - Phone:928-632-1430
Mailing Address - Fax:928-632-1434
Practice Address - Street 1:150 S HWY 69
Practice Address - Street 2:STE 7
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327-9502
Practice Address - Country:US
Practice Address - Phone:928-632-1430
Practice Address - Fax:928-632-1434
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ107078Medicare PIN
AZZ105254Medicare ID - Type Unspecified