Provider Demographics
NPI:1386618940
Name:TRUDERSHEIM, CHARLES ASHLEY (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ASHLEY
Last Name:TRUDERSHEIM
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 1:3405 KENYON ST
Mailing Address - Street 2:STE. 206
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5003
Mailing Address - Country:US
Mailing Address - Phone:619-224-5373
Mailing Address - Fax:619-224-5489
Practice Address - Street 1:3405 KENYON ST
Practice Address - Street 2:STE. 206
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5003
Practice Address - Country:US
Practice Address - Phone:619-224-5373
Practice Address - Fax:619-224-5489
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-29721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC-29721Medicare ID - Type Unspecified