Provider Demographics
NPI:1669509162
Name:HUDGINS, BILL WYATT (DC)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:WYATT
Last Name:HUDGINS
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 1:505 W NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76106-9164
Mailing Address - Country:US
Mailing Address - Phone:817-626-8795
Mailing Address - Fax:817-626-8045
Practice Address - Street 1:505 W NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-9164
Practice Address - Country:US
Practice Address - Phone:817-626-8795
Practice Address - Fax:817-626-8045
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
601403OtherBLUECROSSBLUESHIELD PIN
601403OtherBLUECROSSBLUESHIELD PIN