1649298217 NPI number — RODULFO CHIROPRACTIC PLLC

Table of content: (NPI 1649298217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649298217 NPI number — RODULFO CHIROPRACTIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RODULFO CHIROPRACTIC PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEALING HANDS CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649298217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4564
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27404-4564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-235-4530
Provider Business Mailing Address Fax Number:
336-235-0754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4113 LAWNDALE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27455-1889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-660-0019
Provider Business Practice Location Address Fax Number:
336-235-0754
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODULFO
Authorized Official First Name:
DAMIEN
Authorized Official Middle Name:
JUDE
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
336-235-4530

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  3242 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 085UR . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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