Provider Demographics
NPI:1215140876
Name:WAYNE L RUDNICK DC PC
Entity type:Organization
Organization Name:WAYNE L RUDNICK DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:RUDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-323-8989
Mailing Address - Street 1:570 N COLUMBUS BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2957
Mailing Address - Country:US
Mailing Address - Phone:520-323-8989
Mailing Address - Fax:520-327-9751
Practice Address - Street 1:570 N COLUMBUS BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2957
Practice Address - Country:US
Practice Address - Phone:520-323-8989
Practice Address - Fax:520-327-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ62052Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER