Organization
RANDOM LAKE SPINE & SPORTS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON C RUDELICH D.C. (PRESIDENT)
(920) 994-2000
Entity
Organization
Contact information
Practice address
321 CARROLL ST., RANDOM LAKE, WI 53075
(920) 994-2000
Mailing address
PO BOX 196, RANDOM LAKE, WI 53075-0196
(920) 994-2000
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
03/24/2008
Last updated
06/02/2008
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