Provider Demographics
NPI:1437532702
Name:CHUDY CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:CHUDY CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-922-3796
Mailing Address - Street 1:11 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1039
Mailing Address - Country:US
Mailing Address - Phone:860-922-3796
Mailing Address - Fax:
Practice Address - Street 1:11 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1039
Practice Address - Country:US
Practice Address - Phone:860-922-3796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty