Provider Demographics
NPI:1295896439
Name:HUDSON, ROBERT ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:HUDSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2304 JERSEY RIDGE RD
Mailing Address - Street 2:STE 4
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2378
Mailing Address - Country:US
Mailing Address - Phone:563-289-4262
Mailing Address - Fax:563-344-9444
Practice Address - Street 1:2304 JERSEY RIDGE RD
Practice Address - Street 2:STE 4
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2378
Practice Address - Country:US
Practice Address - Phone:563-355-3555
Practice Address - Fax:563-344-9444
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAA06082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA45737Medicare ID - Type Unspecified
IAU71070Medicare UPIN