Provider Demographics
NPI:1457337198
Name:HUDSON, MONTE WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:MONTE
Middle Name:WAYNE
Last Name:HUDSON
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 1:1920 ACTON HWY
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-5988
Mailing Address - Country:US
Mailing Address - Phone:817-579-0178
Mailing Address - Fax:817-573-0441
Practice Address - Street 1:1920 ACTON HWY
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-5988
Practice Address - Country:US
Practice Address - Phone:817-579-0178
Practice Address - Fax:817-573-0441
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13952Medicare UPIN
TX83M181Medicare PIN