Healthcare Provider Details

I. General information

NPI: 1235201591
Provider Name (Legal Business Name): THOMAS M RUDENKO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11311 VENTURA BLVD
STUDIO CITY CA
91604-3138
US

IV. Provider business mailing address

11311 VENTURA BLVD
STUDIO CITY CA
91604-3138
US

V. Phone/Fax

Practice location:
  • Phone: 818-762-4149
  • Fax:
Mailing address:
  • Phone: 818-762-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC26132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: