Provider Demographics
NPI:1487954137
Name:RUDICK, SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:RUDICK
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 1:3502 W ROGERS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-4749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3502 W ROGERS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-4749
Practice Address - Country:US
Practice Address - Phone:410-367-1966
Practice Address - Fax:410-367-2001
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor