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General NPI Number Information
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NPI Number | 1245479435
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Entity Type | Organization
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Legal Business Name | DRD HEALTHSOURCE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 90 ERIE CANAL DR SUITE D
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City | ROCHESTER
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State | NY
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Zip | 14626-4610
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Country | US
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Telephone | 585-225-6430
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Fax |
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Provider Business Mailing Address
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Address Line | 90 ERIE CANAL DR SUITE D
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City | ROCHESTER
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State | NY
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Zip | 14626-4610
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Country | US
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Telephone | 585-225-6430
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. DONALD R DUDLEY
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Credential | DC,CCSP
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Telephone | 585-225-6430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | X009170
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License Number State | NY
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