Healthcare Provider Details

I. General information

NPI: 1164155792
Provider Name (Legal Business Name): EMILYANN EVE RUDZINSKI DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 BOSTON TPKE
SHREWSBURY MA
01545-3873
US

IV. Provider business mailing address

523 PASAY RD
NORTH GROSVENORDALE CT
06255-1237
US

V. Phone/Fax

Practice location:
  • Phone: 508-425-3304
  • Fax:
Mailing address:
  • Phone: 860-481-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number624
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: