Healthcare Provider Details

I. General information

NPI: 1821149071
Provider Name (Legal Business Name): THOMAS RUDENKO CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 08/22/2020
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: 818-762-4189
Mailing address:
  • Phone: 818-762-4149
  • Fax: 818-762-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. THOMAS MICHAEL RUDENKO
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 818-762-4149