Healthcare Provider Details

I. General information

NPI: 1720018690
Provider Name (Legal Business Name): WILLIAM THOMAS CUDMORE JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 S LAND PARK DR SUITE 200
SACRAMENTO CA
95831-3668
US

IV. Provider business mailing address

7200 S LAND PARK DR SUITE 200
SACRAMENTO CA
95831-3668
US

V. Phone/Fax

Practice location:
  • Phone: 916-424-0828
  • Fax: 916-424-1128
Mailing address:
  • Phone: 916-424-0828
  • Fax: 916-424-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC21595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: