Provider Demographics
NPI:1194902239
Name:RUDNICK, DAVID GRANT (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GRANT
Last Name:RUDNICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8794 BOYNTON BEACH BLVD
Mailing Address - Street 2:STE 107
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-4468
Mailing Address - Country:US
Mailing Address - Phone:561-364-4111
Mailing Address - Fax:561-364-5221
Practice Address - Street 1:8794 BOYNTON BEACH BLVD
Practice Address - Street 2:STE 107
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-4468
Practice Address - Country:US
Practice Address - Phone:561-364-4111
Practice Address - Fax:561-364-5221
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70328OtherBLUE CROSS BLUE SHIELD