Provider Demographics
NPI:1386995314
Name:HUDKINS, ELIZABETH (BA LMT DC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HUDKINS
Suffix:
Gender:F
Credentials:BA LMT DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-9332
Mailing Address - Country:US
Mailing Address - Phone:304-488-0004
Mailing Address - Fax:
Practice Address - Street 1:10595 STRT 550
Practice Address - Street 2:
Practice Address - City:BARLOW
Practice Address - State:OH
Practice Address - Zip Code:45712
Practice Address - Country:US
Practice Address - Phone:304-865-5444
Practice Address - Fax:304-865-5445
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4516111N00000X
WV2012 2990225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist