Healthcare Provider Details

I. General information

NPI: 1376506378
Provider Name (Legal Business Name): ROBERT RUDDY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 STATE ROUTE 89
SENECA FALLS NY
13148-9425
US

IV. Provider business mailing address

2360 STATE ROUTE 89
SENECA FALLS NY
13148-9425
US

V. Phone/Fax

Practice location:
  • Phone: 315-568-3166
  • Fax: 315-568-3700
Mailing address:
  • Phone: 315-568-3166
  • Fax: 315-568-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX008870
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: