Healthcare Provider Details

I. General information

NPI: 1316024045
Provider Name (Legal Business Name): JOHN PAUL DUDLEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
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 TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3883
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3883
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: