Healthcare Provider Details

I. General information

NPI: 1760928741
Provider Name (Legal Business Name): DUDDEY CHIROPRACTIC,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6090 WARNER AVE
HUNTINGTON BEACH CA
92647-5568
US

IV. Provider business mailing address

6090 WARNER AVE
HUNTINGTON BEACH CA
92647-5568
US

V. Phone/Fax

Practice location:
  • Phone: 714-377-0078
  • Fax: 714-377-0622
Mailing address:
  • Phone: 714-377-0078
  • Fax: 714-377-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC21949
License Number StateCA

VIII. Authorized Official

Name: MR. JONATHAN AGUILAR
Title or Position: ADMINISTRATION-DIRECTOR
Credential:
Phone: 714-377-0078