Provider Demographics
NPI:1427065531
Name:DUDYCHA, DAVID WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:DUDYCHA
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 1:3351 UNIVERSITY DR E STE 112
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3470
Mailing Address - Country:US
Mailing Address - Phone:979-776-6808
Mailing Address - Fax:979-776-2090
Practice Address - Street 1:3351 UNIVERSITY DR E STE 112
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3470
Practice Address - Country:US
Practice Address - Phone:979-776-6808
Practice Address - Fax:979-776-2090
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC3025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601515Medicare ID - Type Unspecified