Provider Demographics
NPI:1760928741
Name:DUDDEY CHIROPRACTIC,INC
Entity Type:Organization
Organization Name:DUDDEY CHIROPRACTIC,INC
Other - Org Name:SPORTSCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATION-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-377-0078
Mailing Address - Street 1:6090 WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5568
Mailing Address - Country:US
Mailing Address - Phone:714-377-0078
Mailing Address - Fax:714-377-0622
Practice Address - Street 1:6090 WARNER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5568
Practice Address - Country:US
Practice Address - Phone:714-377-0078
Practice Address - Fax:714-377-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21949111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty