Provider Demographics
NPI:1245367366
Name:HUDSON CHIROPRACTIC PC
Entity type:Organization
Organization Name:HUDSON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LAUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-448-8515
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:49247-0031
Mailing Address - Country:US
Mailing Address - Phone:517-448-8515
Mailing Address - Fax:517-448-3044
Practice Address - Street 1:794 N MAPLE GROVE AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MI
Practice Address - Zip Code:49247-1148
Practice Address - Country:US
Practice Address - Phone:517-448-8515
Practice Address - Fax:517-448-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISL004913OtherPRIVATE INS. PROVIDER ID#
MI4343700Medicaid
MI950D650020OtherBCBSM PROVIDER ID#
OH36362049700OtherWORKERS COMP
MI4343700Medicaid
MISL004913OtherPRIVATE INS. PROVIDER ID#