Provider Demographics
NPI:1720018690
Name:CUDMORE, WILLIAM THOMAS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:CUDMORE
Suffix:JR
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 1:7200 S LAND PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3668
Mailing Address - Country:US
Mailing Address - Phone:916-424-0828
Mailing Address - Fax:916-424-1128
Practice Address - Street 1:7200 S LAND PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3668
Practice Address - Country:US
Practice Address - Phone:916-424-0828
Practice Address - Fax:916-424-1128
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21595111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA043125Medicare UPIN
CADC0215950Medicare ID - Type Unspecified