Provider Demographics
NPI:1194795724
Name:HUDSON, JEFFREY BRIAN (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRIAN
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 1:3030 S TAMIAMI TR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5195
Mailing Address - Country:US
Mailing Address - Phone:941-366-8383
Mailing Address - Fax:941-951-1485
Practice Address - Street 1:3030 S TAMIAMI TR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5195
Practice Address - Country:US
Practice Address - Phone:941-366-8383
Practice Address - Fax:941-951-1485
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4460591OtherAETNA
FL55374OtherBC BS
FL55374Medicare ID - Type Unspecified
U68116Medicare UPIN