Provider Demographics
NPI:1730356361
Name:SHAWN A RUDKIN & ASSOCIATES P C
Entity type:Organization
Organization Name:SHAWN A RUDKIN & ASSOCIATES P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUDKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-722-9999
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:ID
Mailing Address - Zip Code:83660-0154
Mailing Address - Country:US
Mailing Address - Phone:208-722-9999
Mailing Address - Fax:
Practice Address - Street 1:101 E GROVE AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:ID
Practice Address - Zip Code:83660
Practice Address - Country:US
Practice Address - Phone:208-722-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty