MEDICARE: DR. DAMIEN JUDE RODULFO DC, CCSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	3242	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	085UR	OTHER	NC	BCBS NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407838675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMIEN JUDE RODULFO DC, CCSP

Provider Business Mailing Address
First Line	:	2105 W CORNWALLIS DR STE C
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-7098
Country	:	US
Telephone Number	:	336-235-4530
Fax Number	:	336-235-0754

Provider Business Practice Location Address
First Line	:	2105 W CORNWALLIS DR STE C
Second Line	:	A
City	:	GREENSBORO
State	:	NC
Zip	:	27408-7098
Country	:	US
Telephone Number	:	336-235-4530
Fax Number	:	336-235-0754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	04/06/2017

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