Provider Demographics
NPI:1548271950
Name:SCUDERI, RODNEY RAYMOND (DC)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:RAYMOND
Last Name:SCUDERI
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 1:10214 S. SANDY WILLOWS COVE
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4106
Mailing Address - Country:US
Mailing Address - Phone:801-631-2558
Mailing Address - Fax:
Practice Address - Street 1:8915 S 700 E
Practice Address - Street 2:STE. #201
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2422
Practice Address - Country:US
Practice Address - Phone:801-523-6327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176342-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT51019OtherPEHP
UT633116OtherDESERET MUTUAL
UT107001530102OtherIHC
UT51019OtherPEHP