Provider Demographics
NPI:1700835501
Name:HUDAK, HEATHER M (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:M
Last Name:HUDAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:SCHIEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:804 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1227
Mailing Address - Country:US
Mailing Address - Phone:269-983-5527
Mailing Address - Fax:269-983-3610
Practice Address - Street 1:804 ELM ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1227
Practice Address - Country:US
Practice Address - Phone:269-983-5527
Practice Address - Fax:269-983-3610
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200520244051OtherCOMMUNITH CHOICE
MIHH008693OtherBCBS OF MI LICENSE
MI44 30220OtherPHYSICIANS HEALTH PLAN
MI200520244004OtherUNITED HEALTH CARE
MI07483464OtherAETNA
MI44 30220OtherPHYSICIANS HEALTH PLAN
MI200520244004OtherUNITED HEALTH CARE
MIN87600003Medicare ID - Type Unspecified