Provider Demographics
NPI:1437264025
Name:RUDOLPH, CARLA DENYCE (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:DENYCE
Last Name:RUDOLPH
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 1:1139 BUSH STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070
Mailing Address - Country:US
Mailing Address - Phone:650-591-3323
Mailing Address - Fax:650-591-3564
Practice Address - Street 1:1139 BUSH STREET
Practice Address - Street 2:SUITE D
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070
Practice Address - Country:US
Practice Address - Phone:650-591-3323
Practice Address - Fax:650-591-3564
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC168430Medicare ID - Type Unspecified
DC168430Medicare UPIN