Provider Demographics
NPI:1871671867
Name:HUDSON, JAMES L (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:HUDSON
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 1:222 10TH AVE E
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-3114
Mailing Address - Country:US
Mailing Address - Phone:309-787-9660
Mailing Address - Fax:309-787-9678
Practice Address - Street 1:222 10TH AVE E
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-3114
Practice Address - Country:US
Practice Address - Phone:309-787-9660
Practice Address - Fax:309-787-9678
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
918230Medicare ID - Type Unspecified
86501Medicare UPIN