Provider Demographics
NPI:1639218928
Name:HUDSON CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:HUDSON CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-990-2663
Mailing Address - Street 1:7701 E INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4041
Mailing Address - Country:US
Mailing Address - Phone:480-990-2663
Mailing Address - Fax:480-941-2825
Practice Address - Street 1:7701 E INDIAN SCHOOL RD
Practice Address - Street 2:SUITE H
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4041
Practice Address - Country:US
Practice Address - Phone:480-990-2663
Practice Address - Fax:480-941-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZY06071Medicare UPIN
AZ78449Medicare ID - Type Unspecified