Provider Demographics
NPI:1457433625
Name:DUDLEY, MINDA LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:MINDA
Middle Name:LOUISE
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 MISSION ST
Mailing Address - Street 2:SUITE 219
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2468
Mailing Address - Country:US
Mailing Address - Phone:415-648-8900
Mailing Address - Fax:415-648-8901
Practice Address - Street 1:2480 MISSION ST
Practice Address - Street 2:SUITE 219
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2468
Practice Address - Country:US
Practice Address - Phone:415-648-8900
Practice Address - Fax:415-648-8901
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0201670Medicare ID - Type Unspecified