MEDICARE: LAUDERDALE SPORTS PERFORMANCE INSTITUTE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1326897307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUDERDALE SPORTS PERFORMANCE INSTITUTE, PLLC

Provider Business Mailing Address
First Line	:	1441 NW 1ST AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-6037
Country	:	US
Telephone Number	:	415-420-9504
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 POWERLINE RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3172
Country	:	US
Telephone Number	:	415-420-9504
Fax Number	:	954-540-9395

Authorized Official
Title or Position	:	CHIROPRACTOR/OWNER
Name	:	DR. GEOFFREY RUDY
Credential	:	DC
Telephone Number	:	415-420-9504

Provider Enumeration Date	:	05/14/2024
Last Update Date	:	05/16/2024

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