MEDICARE: DR. THOMAS CHARLES DUDDEY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	DC21949	CA

General Provider Information

NPI Number	:	1578625240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS CHARLES DUDDEY DC

Provider Business Mailing Address
First Line	:	6090 WARNER AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5568
Country	:	US
Telephone Number	:	714-377-0078
Fax Number	:	714-377-0622

Provider Business Practice Location Address
First Line	:	6090 WARNER AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5568
Country	:	US
Telephone Number	:	714-377-0078
Fax Number	:	714-377-0622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	01/12/2017

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