Provider Demographics
NPI:1518239714
Name:DUDDEY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:DUDDEY CHIROPRACTIC INC.
Other - Org Name:SPORTSCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DUDDEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-377-0078
Mailing Address - Street 1:5901 WARNER AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4659
Mailing Address - Country:US
Mailing Address - Phone:714-377-0078
Mailing Address - Fax:714-377-0622
Practice Address - Street 1:5901 WARNER AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-4659
Practice Address - Country:US
Practice Address - Phone:714-377-0078
Practice Address - Fax:714-377-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21949261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center