Provider Demographics
NPI:1154867836
Name:RUDKIN, JEREMY (DC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:RUDKIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 CABERFAE TRL
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-3707
Mailing Address - Country:US
Mailing Address - Phone:586-530-8838
Mailing Address - Fax:
Practice Address - Street 1:7900 CABERFAE TRL
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-3707
Practice Address - Country:US
Practice Address - Phone:586-530-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor