MEDICARE: RUMPH CHIROPRACTIC CLINIC PC

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	111N00000X	Chiropractor	2301002727	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2301002727	OTHER	MI	COMMERCIAL
2	950F318420	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1659405868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUMPH CHIROPRACTIC CLINIC PC

Provider Business Mailing Address
First Line	:	5732 WILLIAMS LAKE ROAD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48329-3274
Country	:	US
Telephone Number	:	248-673-1215
Fax Number	:	248-673-7027

Provider Business Practice Location Address
First Line	:	5732 WILLIAMS LAKE ROAD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48329-3274
Country	:	US
Telephone Number	:	248-673-1215
Fax Number	:	248-673-7027

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL ANTHONY RUMPH
Credential	:	DC
Telephone Number	:	248-673-1215

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	06/21/2013

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