Provider Demographics
NPI:1487603288
Name:HUDAK, ERIK T (DC)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:T
Last Name:HUDAK
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 1:804 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1227
Mailing Address - Country:US
Mailing Address - Phone:269-983-5527
Mailing Address - Fax:269-983-3610
Practice Address - Street 1:804 ELM ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1227
Practice Address - Country:US
Practice Address - Phone:269-983-5527
Practice Address - Fax:269-983-3610
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI07589461OtherAETNA
MIEH008692OtherBCBS OF MI LICENSE
MI200520244053OtherCOMMUNITY CHOICE
MI44 30219OtherPHYSICIANS HEALTH PLAN
MIN87600001Medicare ID - Type Unspecified
MIU94294Medicare UPIN
MI44 30219OtherPHYSICIANS HEALTH PLAN