Provider Demographics
NPI:1578666418
Name:CHUDY, LOUIS J (DC)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:J
Last Name:CHUDY
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 1:2304 N GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1602
Mailing Address - Country:US
Mailing Address - Phone:262-542-6900
Mailing Address - Fax:262-522-3981
Practice Address - Street 1:2304 N GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1602
Practice Address - Country:US
Practice Address - Phone:262-542-6900
Practice Address - Fax:262-522-3981
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2276111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38833500Medicaid
WI391599318OtherFEDERAL TAX ID #
WI391599318OtherFEDERAL TAX ID #
WIT61666Medicare UPIN