=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992920409
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN M RUDACK DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 06/08/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8685 W SAHARA AVE STE 180
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89117-5877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-362-0336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8685 W SAHARA AVE STE 180
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89117-5877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-362-0336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | B211
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------