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General NPI Number Information
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NPI Number | 1124114582
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Entity Type | Organization
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Legal Business Name | KUDICK CHIROPRACTIC P.S.
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 06/07/2010
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Provider Practice Location Address
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Address Line | 1800 COOPER POINT RD SW BUILDING 24A
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City | OLYMPIA
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State | WA
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Zip | 98502
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Country | US
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Telephone | 360-943-7360
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Fax | 360-754-7022
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Provider Business Mailing Address
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Address Line | PO BOX 2252
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City | OLYMPIA
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State | WA
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Zip | 98507
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Country | US
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Telephone | 360-943-7360
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Fax | 360-754-7022
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUZAN IRENE KUDICK
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Credential | DC
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Telephone | 360-943-7360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 00002433
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License Number State | WA
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