Provider Demographics
NPI:1790891034
Name:CUDNIK, BRAD ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ALAN
Last Name:CUDNIK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3003 LETITIA LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5115
Mailing Address - Country:US
Mailing Address - Phone:210-269-4383
Mailing Address - Fax:210-333-6884
Practice Address - Street 1:6207 PECAN VALLEY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3226
Practice Address - Country:US
Practice Address - Phone:210-359-9100
Practice Address - Fax:210-333-6884
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12854Medicare UPIN
TX8F1235Medicare PIN