Healthcare Provider Details

I. General information

NPI: 1477741262
Provider Name (Legal Business Name): MICHAEL ERIC UDO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 LAKEVIEW DR
SPRING GROVE PA
17362-8449
US

IV. Provider business mailing address

515 LAKEVIEW DR
SPRING GROVE PA
17362-8449
US

V. Phone/Fax

Practice location:
  • Phone: 717-225-3728
  • Fax:
Mailing address:
  • Phone: 717-225-3728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-005425-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: