Provider Demographics
NPI:1932103538
Name:HUDGINS, ERVIN JACKSON (DC)
Entity Type:Individual
Prefix:DR
First Name:ERVIN
Middle Name:JACKSON
Last Name:HUDGINS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ERVIN
Other - Middle Name:JACKSON
Other - Last Name:HUDGINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC PA
Mailing Address - Street 1:7214 HIGHWAY 78
Mailing Address - Street 2:STE 5
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-2532
Mailing Address - Country:US
Mailing Address - Phone:972-429-6379
Mailing Address - Fax:
Practice Address - Street 1:7214 HIGHWAY 78
Practice Address - Street 2:STE 5
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-2532
Practice Address - Country:US
Practice Address - Phone:972-429-6379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2013-04-04
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
TX9273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00200813OtherRAILROAD MEDICARE
TX0082216OtherBLUE LINK
TX8K9184OtherMEDICARE
TX9365910OtherPHCS
TXB0082216OtherBLUECROSSBLUESHIELD