Healthcare Provider Details

I. General information

NPI: 1063717098
Provider Name (Legal Business Name): JONATHAN JAMES RUDE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2011
Last Update Date: 01/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8843 NEWCASTLE AVE
NORTHRIDGE CA
91325-3151
US

IV. Provider business mailing address

8843 NEWCASTLE AVE
NORTHRIDGE CA
91325-3151
US

V. Phone/Fax

Practice location:
  • Phone: 818-237-6494
  • Fax: 818-349-6617
Mailing address:
  • Phone: 818-237-6494
  • Fax: 818-349-6617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC16841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: