Provider Demographics
NPI:1821149071
Name:THOMAS RUDENKO CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:THOMAS RUDENKO CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RUDENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-762-4149
Mailing Address - Street 1:11311 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3138
Mailing Address - Country:US
Mailing Address - Phone:818-762-4149
Mailing Address - Fax:818-762-4189
Practice Address - Street 1:11311 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3138
Practice Address - Country:US
Practice Address - Phone:818-762-4149
Practice Address - Fax:818-762-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26132111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty