Provider Demographics
NPI:1568778520
Name:WASHINGTON WELLNESS, PLLC
Entity Type:Organization
Organization Name:WASHINGTON WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HUDAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-948-2225
Mailing Address - Street 1:906 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3533
Mailing Address - Country:US
Mailing Address - Phone:252-948-2225
Mailing Address - Fax:252-974-7607
Practice Address - Street 1:906 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3533
Practice Address - Country:US
Practice Address - Phone:252-948-2225
Practice Address - Fax:252-974-7607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty