MEDICARE: DR. HEATHER M HUDAK D.C.

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	111N00000X	Chiropractor	2301008693	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200520244051	OTHER	MI	COMMUNITH CHOICE
2	HH008693	OTHER	MI	BCBS OF MI LICENSE
3	44 30220	OTHER	MI	PHYSICIANS HEALTH PLAN
4	200520244004	OTHER	MI	UNITED HEALTH CARE
5	07483464	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1700835501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER M HUDAK D.C.

Provider Business Mailing Address
First Line	:	804 ELM ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-1227
Country	:	US
Telephone Number	:	269-983-5527
Fax Number	:	269-983-3610

Provider Business Practice Location Address
First Line	:	804 ELM ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-1227
Country	:	US
Telephone Number	:	269-983-5527
Fax Number	:	269-983-3610

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/23/2007

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