Provider Demographics
NPI:1538754353
Name:HUDSON, MARK J TROY III (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J TROY
Last Name:HUDSON
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JETT
Other - Middle Name:
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1 N CENTRAL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4416
Mailing Address - Country:US
Mailing Address - Phone:602-368-3578
Mailing Address - Fax:
Practice Address - Street 1:1 N CENTRAL AVE STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4416
Practice Address - Country:US
Practice Address - Phone:602-368-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor