Provider Demographics
NPI:1437215167
Name:RUDDY, PATRICK JOSEPH I (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:RUDDY
Suffix:I
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 1:2268 S M 76
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-8700
Mailing Address - Country:US
Mailing Address - Phone:989-345-0010
Mailing Address - Fax:989-345-0014
Practice Address - Street 1:2268 S M 76
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-8700
Practice Address - Country:US
Practice Address - Phone:898-934-5001
Practice Address - Fax:989-345-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP43270Medicare PIN