Provider Demographics
NPI:1427021641
Name:TRAUDT, JOHN (DC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:TRAUDT
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 1:1694 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-4002
Mailing Address - Country:US
Mailing Address - Phone:518-869-3884
Mailing Address - Fax:518-869-6030
Practice Address - Street 1:1694 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4002
Practice Address - Country:US
Practice Address - Phone:518-869-3884
Practice Address - Fax:518-869-6030
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009067-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU82052Medicare UPIN
NYDA5067Medicare ID - Type Unspecified