Healthcare Provider Details

I. General information

NPI: 1124114582
Provider Name (Legal Business Name): KUDICK CHIROPRACTIC P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COOPER POINT RD SW BUILDING 24A
OLYMPIA WA
98502
US

IV. Provider business mailing address

PO BOX 2252
OLYMPIA WA
98507
US

V. Phone/Fax

Practice location:
  • Phone: 360-943-7360
  • Fax: 360-754-7022
Mailing address:
  • Phone: 360-943-7360
  • Fax: 360-754-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number00002433
License Number StateWA

VIII. Authorized Official

Name: DR. SUZAN IRENE KUDICK
Title or Position: PRESIDENT
Credential: DC
Phone: 360-943-7360