Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC26132 | CA |
NPI | 1235201591 |
---|---|
Provider Name | Dr. Thomas M Rudenko |
First Address | Studio City, CA 91604-3138 |
Second Address | Studio City, CA 91604-3138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |