MEDICARE: DR. RODNEY RAYMOND SCUDERI 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	176342-1202	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51019	OTHER	UT	PEHP
2	633116	OTHER	UT	DESERET MUTUAL
3	107001530102	OTHER	UT	IHC

General Provider Information

NPI Number	:	1548271950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODNEY RAYMOND SCUDERI D.C.

Provider Business Mailing Address
First Line	:	10214 S. SANDY WILLOWS COVE
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-4106
Country	:	US
Telephone Number	:	801-631-2558
Fax Number	:

Provider Business Practice Location Address
First Line	:	8915 S 700 E
Second Line	:	STE. #201
City	:	SANDY
State	:	UT
Zip	:	84070-2422
Country	:	US
Telephone Number	:	801-523-6327
Fax Number	:

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	11/28/2007

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