Provider Demographics
NPI:1700053220
Name:HUDEC CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:HUDEC CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HUDEC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-641-7811
Mailing Address - Street 1:10595 OLD ALABAMA ROAD CONNECTOR
Mailing Address - Street 2:STE 9A
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022
Mailing Address - Country:US
Mailing Address - Phone:770-641-7811
Mailing Address - Fax:770-641-0336
Practice Address - Street 1:10595 OLD ALABAMA ROAD CONNECTOR
Practice Address - Street 2:STE 9A
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022
Practice Address - Country:US
Practice Address - Phone:770-641-7811
Practice Address - Fax:770-641-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6983Medicare PIN