Healthcare Provider Details

I. General information

NPI: 1982874442
Provider Name (Legal Business Name): CHARLES F. HUDSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 MANATEE AVE W
BRADENTON FL
34205-4241
US

IV. Provider business mailing address

3002 MANATEE AVE W
BRADENTON FL
34205-4241
US

V. Phone/Fax

Practice location:
  • Phone: 941-746-4531
  • Fax: 941-745-2046
Mailing address:
  • Phone: 941-746-4531
  • Fax: 941-745-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCH1291
License Number StateFL

VIII. Authorized Official

Name: CHARLES F HUDSON
Title or Position: DOCTOR/MANAGER
Credential: D.C.
Phone: 941-746-4531