Healthcare Provider Details

I. General information

NPI: 1497534804
Provider Name (Legal Business Name): EVAN RUDD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SKINNER BLVD
DUNEDIN FL
34698-4995
US

IV. Provider business mailing address

424 SKINNER BLVD
DUNEDIN FL
34698-4995
US

V. Phone/Fax

Practice location:
  • Phone: 727-599-1039
  • Fax:
Mailing address:
  • Phone: 727-330-6718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: