Provider Demographics
NPI:1316024045
Name:DUDLEY, JOHN PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:DUDLEY
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 1:301 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-3207
Mailing Address - Country:US
Mailing Address - Phone:704-663-2010
Mailing Address - Fax:704-660-9292
Practice Address - Street 1:301 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-3207
Practice Address - Country:US
Practice Address - Phone:704-663-2010
Practice Address - Fax:704-660-9292
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3883171100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTHT005265-001OtherEB TRADING PARTNER #
UT000057834Medicare ID - Type Unspecified
UTHT005265-001OtherEB TRADING PARTNER #