Provider Demographics
NPI:1407024268
Name:TRUDNAK, BRIAN J (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:TRUDNAK
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 1:833 ROUTE 28
Mailing Address - Street 2:ROUTE 28
Mailing Address - City:S YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-5254
Mailing Address - Country:US
Mailing Address - Phone:508-394-1353
Mailing Address - Fax:508-398-2866
Practice Address - Street 1:833 ROUTE 28
Practice Address - Street 2:ROUTE 28
Practice Address - City:S YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-5254
Practice Address - Country:US
Practice Address - Phone:508-394-1353
Practice Address - Fax:508-398-2866
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA03177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9252400OtherCIGNA
MAAA118776OtherHARVARD PILGRIM HEALTHCARE
MA1112700OtherFALLON
MA11824901OtherCAQH
MA9340113OtherAETNA
MA9340113OtherAETNA