Provider Demographics
NPI:1295808186
Name:LUDOVICO, MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LUDOVICO
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 1:190 W 25TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2272
Mailing Address - Country:US
Mailing Address - Phone:650-349-2222
Mailing Address - Fax:650-341-3415
Practice Address - Street 1:190 W 25TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2272
Practice Address - Country:US
Practice Address - Phone:650-349-2222
Practice Address - Fax:650-341-3415
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor