Provider Demographics
NPI:1720389323
Name:AMICAY, RUDY ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:RUDY
Middle Name:ANDREW
Last Name:AMICAY
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 1:5 UPPER NEWPORT PLAZA
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:714-966-1436
Mailing Address - Fax:
Practice Address - Street 1:5 UPPER NEWPORT PLAZA
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:714-966-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAZZZ50883YMedicare PIN