Provider Demographics
NPI:1538274857
Name:RUDIN, MARC EVAN (DC)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:EVAN
Last Name:RUDIN
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 1:91 WEST ST
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-2420
Mailing Address - Country:US
Mailing Address - Phone:413-637-0311
Mailing Address - Fax:
Practice Address - Street 1:68 MAIN ST
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2399
Practice Address - Country:US
Practice Address - Phone:413-637-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45078Medicare ID - Type Unspecified