Provider Demographics
NPI:1629726963
Name:RENSHAW RUDDELL, MATTHEW (ND)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:RENSHAW RUDDELL
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 NW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3532
Mailing Address - Country:US
Mailing Address - Phone:503-266-7443
Mailing Address - Fax:
Practice Address - Street 1:452 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3532
Practice Address - Country:US
Practice Address - Phone:503-266-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4389175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath