Provider Demographics
NPI:1457555302
Name:E CHARLES HUDSON D C A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:E CHARLES HUDSON D C A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-436-2081
Mailing Address - Street 1:7 NW 72ND ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1860
Mailing Address - Country:US
Mailing Address - Phone:816-436-2081
Mailing Address - Fax:816-436-2090
Practice Address - Street 1:7 NW 72ND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-1860
Practice Address - Country:US
Practice Address - Phone:816-436-2081
Practice Address - Fax:816-436-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP69C673Medicare ID - Type UnspecifiedINDIVIDUAL
MOP690000Medicare ID - Type UnspecifiedPROF CORP