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General NPI Number Information
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NPI Number | 1720290414
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Entity Type | Individual
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Provider Name | SCOTT ALEXANDER RUDELL SR. DC
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 315 E COTATI AVE SUITE E
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City | COTATI
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State | CA
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Zip | 94931
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Country | US
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Telephone | 707-795-0057
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Fax | 707-795-9517
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Provider Business Mailing Address
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Address Line | 315 E COTATI AVE SUITE E
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City | COTATI
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State | CA
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Zip | 94931
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Country | US
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Telephone | 707-795-0057
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Fax | 707-795-9517
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 11369
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License Number State | CA
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