Healthcare Provider Details

I. General information

NPI: 1639181621
Provider Name (Legal Business Name): RUDY N HEISER D.C., D.A.C.B.R.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 66TH ST N NUHS WHOLE HEALTH CENTER
PINELLAS PARK FL
33781-4005
US

IV. Provider business mailing address

441 33RD ST N APT 215
SAINT PETERSBURG FL
33713-9054
US

V. Phone/Fax

Practice location:
  • Phone: 727-341-3760
  • Fax: 727-302-6610
Mailing address:
  • Phone: 704-804-6971
  • Fax: 727-302-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberCFC 9
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3343
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.011037
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberCH 10315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: