Provider Demographics
NPI:1578019576
Name:BUDAVICH, MATTHEW (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BUDAVICH
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 1:1248 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6340
Mailing Address - Country:US
Mailing Address - Phone:757-755-5565
Mailing Address - Fax:
Practice Address - Street 1:10210 PROSPERITY PARK DR STE 400
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-2666
Practice Address - Country:US
Practice Address - Phone:757-755-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557370111N00000X
NC4942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor