MEDICARE: DR. BERNARD JOSEPH RUMPH DC

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	2301009123	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2301009123	OTHER	MI	COMMERCIAL
2	95 F3 2972 0	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1780716886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNARD JOSEPH RUMPH DC

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. BERNARD JOSEPH RUMPH DC” Practice Location

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