Provider Demographics
NPI:1326897307
Name:LAUDERDALE SPORTS PERFORMANCE INSTITUTE, PLLC
Entity type:Organization
Organization Name:LAUDERDALE SPORTS PERFORMANCE INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-420-9504
Mailing Address - Street 1:1441 NW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6037
Mailing Address - Country:US
Mailing Address - Phone:415-420-9504
Mailing Address - Fax:
Practice Address - Street 1:5300 POWERLINE RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3172
Practice Address - Country:US
Practice Address - Phone:415-420-9504
Practice Address - Fax:954-540-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty