Provider Demographics
NPI:1932130804
Name:BUDNY, DAVID A (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:BUDNY
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 1:11820 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3003
Mailing Address - Country:US
Mailing Address - Phone:216-228-6622
Mailing Address - Fax:216-228-0884
Practice Address - Street 1:11820 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3003
Practice Address - Country:US
Practice Address - Phone:216-228-6622
Practice Address - Fax:216-228-0884
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000139082OtherANTHEM BC/BS
OH341797995OtherTAX ID
OH34179799500OtherBWC GROUP
OH104382301OtherDEPT OF LABOR
OH3417979954A11OtherBC/BS
OH34179799500OtherBWC GROUP
OH104382301OtherDEPT OF LABOR
OHBU0735232Medicare PIN