Provider Demographics
NPI:1992920409
Name:RUDACK, STEVEN M (DC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:RUDACK
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 1:8685 W SAHARA AVE
Mailing Address - Street 2:STE 180
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5877
Mailing Address - Country:US
Mailing Address - Phone:702-362-0336
Mailing Address - Fax:
Practice Address - Street 1:8685 W SAHARA AVE
Practice Address - Street 2:STE 180
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5877
Practice Address - Country:US
Practice Address - Phone:702-362-0336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TG7347Medicare UPIN