Provider Demographics
NPI:1518056555
Name:HUDSON, DUANE CONRAD (DC)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:CONRAD
Last Name:HUDSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11075 S STATE ST STE 29
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5144
Mailing Address - Country:US
Mailing Address - Phone:801-748-2252
Mailing Address - Fax:801-990-4301
Practice Address - Street 1:11075 S STATE ST STE 29
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5144
Practice Address - Country:US
Practice Address - Phone:801-748-2252
Practice Address - Fax:801-990-4301
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5730710-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012742Medicare PIN