Provider Demographics
NPI:1558540302
Name:HUDGENS, MATHEW (CMT, LAC)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:HUDGENS
Suffix:
Gender:M
Credentials:CMT, LAC
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:HUDGENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, CMT
Mailing Address - Street 1:PO BOX 3767
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80307-3767
Mailing Address - Country:US
Mailing Address - Phone:970-393-9777
Mailing Address - Fax:
Practice Address - Street 1:1800 30TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-888-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2019-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
CO2249171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist