Provider Demographics
NPI:1649228883
Name:RUDIN, FRED BRUCE (DC)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:BRUCE
Last Name:RUDIN
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 1:10920 71ST RD
Mailing Address - Street 2:1D
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4848
Mailing Address - Country:US
Mailing Address - Phone:718-544-9797
Mailing Address - Fax:718-520-4337
Practice Address - Street 1:10920 71ST RD
Practice Address - Street 2:1D
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4848
Practice Address - Country:US
Practice Address - Phone:718-544-9797
Practice Address - Fax:718-520-4337
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor