Organization
DRD HEALTHSOURCE CHIROPRACTIC PLLC
Active
Other names
HealthSource Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD R DUDLEY DC,CCSP (CHIROPRACTOR)
(585) 225-6430
Entity
Organization
Contact information
Practice address
90 ERIE CANAL DR, SUITE D, ROCHESTER, NY 14626-4610
(585) 225-6430
Mailing address
90 ERIE CANAL DR, SUITE D, ROCHESTER, NY 14626-4610
(585) 225-6430
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
X009170
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106032AN
PREFERRED CARE
—
01
—
647276
UNITED HEALTHCARE
NY
01
—
7067356
AETNA
NY
01
—
C09170-4
WORKERS COMPENSATION
NY
01
—
P010009170
BLUE CHOICE
NY
01
—
P020009170
EXCELLUS BLUE CROSS/BLUE SHIELD
NY
Enumeration date
02/11/2009
Last updated
08/20/2009
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