Provider Demographics
NPI:1396263711
Name:MARK S HUDSON RELIEF CARE CHIROPRACTIC
Entity type:Organization
Organization Name:MARK S HUDSON RELIEF CARE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-773-5076
Mailing Address - Street 1:460 W MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-7127
Mailing Address - Country:US
Mailing Address - Phone:941-773-5076
Mailing Address - Fax:
Practice Address - Street 1:460 W MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-7127
Practice Address - Country:US
Practice Address - Phone:941-773-5076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty