Provider Demographics
NPI:1447222195
Name:LOPEZ, RENEE HUDOBA (DC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:HUDOBA
Last Name:LOPEZ
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 1:401 N SECTION ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2613
Mailing Address - Country:US
Mailing Address - Phone:251-928-5058
Mailing Address - Fax:251-928-5666
Practice Address - Street 1:401 N SECTION ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2613
Practice Address - Country:US
Practice Address - Phone:251-928-5058
Practice Address - Fax:251-928-5666
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL11209151OtherAETNA/CAQH
AL051507949OtherBCBS
AL46674OtherHEALTHSPRINGS OF ALABAMA
AL051507949OtherBCBS
AL051551574Medicare ID - Type Unspecified