Provider Demographics
NPI:1205995974
Name:HUDAK, MICHAEL JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:HUDAK
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 1:10799 HIGHWAY 707
Mailing Address - Street 2:STE 3
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-9819
Mailing Address - Country:US
Mailing Address - Phone:843-651-2522
Mailing Address - Fax:843-651-2499
Practice Address - Street 1:10799 HIGHWAY 707
Practice Address - Street 2:STE 3
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9819
Practice Address - Country:US
Practice Address - Phone:843-651-2522
Practice Address - Fax:843-651-2499
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2222Medicaid
SCCH2222Medicaid
SCU597160281Medicare PIN