Provider Demographics
NPI:1639181621
Name:HEISER, RUDY N (DC, DACBR)
Entity Type:Individual
Prefix:DR
First Name:RUDY
Middle Name:N
Last Name:HEISER
Suffix:
Gender:M
Credentials:DC, DACBR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 33RD ST N
Mailing Address - Street 2:APT 215
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-9054
Mailing Address - Country:US
Mailing Address - Phone:704-804-6971
Mailing Address - Fax:727-302-6610
Practice Address - Street 1:7200 66TH ST N
Practice Address - Street 2:NUHS WHOLE HEALTH CENTER
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-4005
Practice Address - Country:US
Practice Address - Phone:727-341-3760
Practice Address - Fax:727-302-6610
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCFC 9111NR0200X
NC3343111N00000X
IL038.011037111N00000X
FLCH 10315111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900616Medicaid
085VPOtherBLUEBROSS BLUESHIELD
085VPOtherBLUEBROSS BLUESHIELD
NC5900616Medicaid