Provider Demographics
NPI:1356463038
Name:RUDDY, CHRISTINA (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:RUDDY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 86 WOLCOTT HILL RD
Mailing Address - Street 2:SUITE H1
Mailing Address - City:WETHERSHIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109
Mailing Address - Country:US
Mailing Address - Phone:860-296-4446
Mailing Address - Fax:860-296-0041
Practice Address - Street 1:82 86 WOLCOTT HILL RD
Practice Address - Street 2:SUITE H1
Practice Address - City:WETHERSHIELD
Practice Address - State:CT
Practice Address - Zip Code:06109
Practice Address - Country:US
Practice Address - Phone:860-296-4446
Practice Address - Fax:860-296-0041
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT161900OtherCT CARE