Provider Demographics
NPI:1760478374
Name:DUDICK, MICHAEL G (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:DUDICK
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 1:377 ROUTE 146
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3404
Mailing Address - Country:US
Mailing Address - Phone:518-664-2673
Mailing Address - Fax:518-664-2677
Practice Address - Street 1:377 ROUTE 146
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3404
Practice Address - Country:US
Practice Address - Phone:518-664-2673
Practice Address - Fax:518-664-2677
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
NYX005172111N00000X
TX4431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD1204Medicare ID - Type Unspecified
NYT81271Medicare UPIN