Healthcare Provider Details

I. General information

NPI: 1467620542
Provider Name (Legal Business Name): DUDLEY CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S BROAD ST
MOORESVILLE NC
28115-3207
US

IV. Provider business mailing address

301 S BROAD ST
MOORESVILLE NC
28115-3207
US

V. Phone/Fax

Practice location:
  • Phone: 704-663-2010
  • Fax: 704-660-9292
Mailing address:
  • Phone: 704-663-2010
  • Fax: 704-660-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3883
License Number StateNC

VIII. Authorized Official

Name: DR. JOHN DUDLEY
Title or Position: OWNER
Credential: DC
Phone: 980-254-8800