Provider Demographics
NPI:1215398516
Name:RUDA CHIROPRACTIC INC
Entity Type:Organization
Organization Name:RUDA CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-481-8508
Mailing Address - Street 1:130 S HALCYON RD STE B
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3116
Mailing Address - Country:US
Mailing Address - Phone:805-481-8508
Mailing Address - Fax:
Practice Address - Street 1:130 S HALCYON RD STE B
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3116
Practice Address - Country:US
Practice Address - Phone:805-481-8508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22148Medicare PIN
CAU48548Medicare UPIN