Provider Demographics
NPI:1053418269
Name:MICHAEL DUDICK
Entity type:Organization
Organization Name:MICHAEL DUDICK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-664-2673
Mailing Address - Street 1:377 ROUTE 146
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3404
Mailing Address - Country:US
Mailing Address - Phone:518-664-2673
Mailing Address - Fax:518-664-2677
Practice Address - Street 1:377 ROUTE 146
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3404
Practice Address - Country:US
Practice Address - Phone:518-664-2673
Practice Address - Fax:518-664-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty