Provider Demographics
NPI:1134615818
Name:CHUDYBA, ZD (MSOM, LICENSED ACUPU)
Entity type:Individual
Prefix:
First Name:ZD
Middle Name:
Last Name:CHUDYBA
Suffix:
Gender:F
Credentials:MSOM, LICENSED ACUPU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WEST MAIN STREET
Mailing Address - Street 2:STE 1
Mailing Address - City:MIDWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84049
Mailing Address - Country:US
Mailing Address - Phone:435-503-5682
Mailing Address - Fax:
Practice Address - Street 1:41 WEST MAIN STREET
Practice Address - Street 2:STE 1
Practice Address - City:MIDWAY
Practice Address - State:UT
Practice Address - Zip Code:84048
Practice Address - Country:US
Practice Address - Phone:435-503-5682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5719233-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist