Provider Demographics
NPI:1699728717
Name:HUDAK, BRIAN E (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
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 1:906 W 15TH STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-1209
Mailing Address - Country:US
Mailing Address - Phone:252-948-2225
Mailing Address - Fax:252-974-7607
Practice Address - Street 1:906 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3533
Practice Address - Country:US
Practice Address - Phone:252-948-2225
Practice Address - Fax:252-974-7607
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00648000111N00000X
NC3888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor