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General NPI Number Information
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NPI Number | 1376698787
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Entity Type | Organization
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Legal Business Name | CANYON RIDGE CHIROPRACTIC PC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7280 LAGAE RD SUITE B
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City | CASTLE ROCK
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State | CO
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Zip | 80108-9452
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Country | US
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Telephone | 330-660-3505
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Fax | 303-660-8905
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Provider Business Mailing Address
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Address Line | 7280 LAGAE RD SUITE B
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City | CASTLE ROCK
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State | CO
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Zip | 80108-9452
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Country | US
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Telephone | 330-660-3505
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Fax | 303-660-8905
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRYAN J RUDIAK
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Credential | DC
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Telephone | 303-660-3505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5943
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License Number State | CO
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