Provider Demographics
NPI:1467620542
Name:DUDLEY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:DUDLEY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:980-254-8800
Mailing Address - Street 1:301 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-3207
Mailing Address - Country:US
Mailing Address - Phone:704-663-2010
Mailing Address - Fax:704-660-9292
Practice Address - Street 1:301 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-3207
Practice Address - Country:US
Practice Address - Phone:704-663-2010
Practice Address - Fax:704-660-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057834Medicare PIN
UTU58426Medicare UPIN
UT005783401Medicare PIN