Healthcare Provider Details

I. General information

NPI: 1467517268
Provider Name (Legal Business Name): DAVID D BUDAJ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 HARDWOODS DRIVE
WEST BLOOMFIELD MI
48323
US

IV. Provider business mailing address

4923 HARDWOODS DR
WEST BLOOMFIELD MI
48323-2644
US

V. Phone/Fax

Practice location:
  • Phone: 248-706-1245
  • Fax:
Mailing address:
  • Phone: 248-706-1245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2301007674
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: