MEDICARE: DR. CHARLES ASHLEY TRUDERSHEIM D.C.

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	DC-29721	CA

General Provider Information

NPI Number	:	1386618940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ASHLEY TRUDERSHEIM D.C.

Provider Business Mailing Address
First Line	:	3405 KENYON ST
Second Line	:	STE. 206
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5003
Country	:	US
Telephone Number	:	619-224-5373
Fax Number	:	619-224-5489

Provider Business Practice Location Address
First Line	:	3405 KENYON ST
Second Line	:	STE. 206
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5003
Country	:	US
Telephone Number	:	619-224-5373
Fax Number	:	619-224-5489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	07/08/2007

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