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General NPI Number Information
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NPI Number | 1720067051
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Entity Type | Individual
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Provider Name | PHILIP S DUDAK DC, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 11133 DUNN RD
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6163
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Country | US
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Telephone | 314-653-5228
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Fax |
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Provider Business Mailing Address
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Address Line | 11125 DUNN RD STE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6132
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Country | US
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Telephone | 314-653-5228
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 005778
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2013003629
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038006559
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209010226
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2013003629
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License Number State | MO
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209010226
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License Number State | IL
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