Provider Demographics
NPI:1720204043
Name:RUDE, DANIEL MONROE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MONROE
Last Name:RUDE
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 1:2320 S ROBERTSON BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2053
Mailing Address - Country:US
Mailing Address - Phone:310-280-0600
Mailing Address - Fax:
Practice Address - Street 1:2320 S ROBERTSON BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2053
Practice Address - Country:US
Practice Address - Phone:310-280-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 23972111N00000X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23972Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER