Healthcare Provider Details

I. General information

NPI: 1558540302
Provider Name (Legal Business Name): MATHEW HUDGENS CMT, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATTHEW HUDGENS LAC, CMT

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 11/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 30TH ST
BOULDER CO
80301
US

IV. Provider business mailing address

PO BOX 3767
BOULDER CO
80307-3767
US

V. Phone/Fax

Practice location:
  • Phone: 303-888-5291
  • Fax:
Mailing address:
  • Phone: 970-393-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2249
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: