Provider Demographics
NPI:1477705689
Name:PUDNIK, INC
Entity Type:Organization
Organization Name:PUDNIK, INC
Other - Org Name:INNATE HEALTH CHIROPRACTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-325-4456
Mailing Address - Street 1:1413 CLEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2763
Mailing Address - Country:US
Mailing Address - Phone:972-325-4456
Mailing Address - Fax:972-635-5293
Practice Address - Street 1:1514 N GREENVILLE AVE
Practice Address - Street 2:STE 340
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-1202
Practice Address - Country:US
Practice Address - Phone:972-325-4456
Practice Address - Fax:972-635-5293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603787OtherBCBS
TXU02884Medicare UPIN
TX0A5291Medicare PIN