Provider Demographics
NPI:1497534804
Name:RUDD, EVAN (DC)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:RUDD
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 1:424 SKINNER BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-4995
Mailing Address - Country:US
Mailing Address - Phone:727-330-6718
Mailing Address - Fax:
Practice Address - Street 1:424 SKINNER BLVD
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4995
Practice Address - Country:US
Practice Address - Phone:727-599-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor