Healthcare Provider Details

I. General information

NPI: 1548320906
Provider Name (Legal Business Name): KUDER ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 CLEAR CREEK ST
BLACKHAWK CO
80422
US

IV. Provider business mailing address

PO BOX 418
BLACKHAWK CO
80422
US

V. Phone/Fax

Practice location:
  • Phone: 303-582-9205
  • Fax: 303-582-9270
Mailing address:
  • Phone: 303-582-9205
  • Fax: 303-582-9270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4843
License Number StateCO

VIII. Authorized Official

Name: DR. HEATHER PAULINE KUDER
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 303-582-9205