Provider Demographics
NPI:1942379482
Name:TRUDELL, BRENDA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:LYNN
Last Name:TRUDELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3234 VALLEY SPRING RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-1236
Mailing Address - Country:US
Mailing Address - Phone:608-963-6748
Mailing Address - Fax:
Practice Address - Street 1:1861 BUSINESS HWY 18 151 EAST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-1236
Practice Address - Country:US
Practice Address - Phone:608-437-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4217-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor