Provider Demographics
NPI:1659426054
Name:RUDIAK, BRYAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:J
Last Name:RUDIAK
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 1:7280 LAGAE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9452
Mailing Address - Country:US
Mailing Address - Phone:303-660-3505
Mailing Address - Fax:303-660-8905
Practice Address - Street 1:7280 LAGAE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-9452
Practice Address - Country:US
Practice Address - Phone:303-660-3505
Practice Address - Fax:303-660-8905
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor