Provider Demographics
NPI:1619134632
Name:ERVIN JACKSON HUDGINS DC PA
Entity Type:Organization
Organization Name:ERVIN JACKSON HUDGINS DC PA
Other - Org Name:BEYOND CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTIC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERVIN
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:HUDGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC PA
Authorized Official - Phone:806-794-6907
Mailing Address - Street 1:7214 HIGHWAY 78
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-2532
Mailing Address - Country:US
Mailing Address - Phone:972-429-6379
Mailing Address - Fax:
Practice Address - Street 1:7214 HIGHWAY 78
Practice Address - Street 2:SUITE 5
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-2532
Practice Address - Country:US
Practice Address - Phone:972-429-6379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9365910OtherFIRSTCARE PHCS
TXU91516OtherALL COMMERCIAL
TXP00200813OtherRAILROAD MEDICARE
TXU91516OtherUNITEDHEALTHCARE
TXB0082216OtherBLUECROSSBLUESHIELD
TXU91516OtherAETNA
TXU91516OtherAETNA