Provider Demographics
NPI:1821170804
Name:HUDGINS, DIANA JOHNSON (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:JOHNSON
Last Name:HUDGINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 US HWY 431 N
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957
Mailing Address - Country:US
Mailing Address - Phone:256-593-6158
Mailing Address - Fax:256-593-6175
Practice Address - Street 1:2030 US HWY 431 N
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957
Practice Address - Country:US
Practice Address - Phone:256-593-6158
Practice Address - Fax:256-593-6175
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT91415Medicare UPIN
AL000072543Medicare PIN