MEDICARE: WAYNE L RUDNICK DC PC

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	5512	AZ

General Provider Information

NPI Number	:	1215140876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE L RUDNICK DC PC

Provider Business Mailing Address
First Line	:	570 N COLUMBUS BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2957
Country	:	US
Telephone Number	:	520-323-8989
Fax Number	:	520-327-9751

Provider Business Practice Location Address
First Line	:	570 N COLUMBUS BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2957
Country	:	US
Telephone Number	:	520-323-8989
Fax Number	:	520-327-9751

Authorized Official
Title or Position	:	DOCTOR OWNER
Name	:	DR. WAYNE LLOYD RUDNICK
Credential	:	DC
Telephone Number	:	520-323-8989

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	12/21/2007

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