Healthcare Provider Details

I. General information

NPI: 1629323134
Provider Name (Legal Business Name): TOTAL WELLNESS CENTER OF ACADIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RIVER ROAD
LAFAYETTE LA
70501
US

IV. Provider business mailing address

106 OIL CENTER DRIVE SUITE 109
LAFAYETTE LA
70503
US

V. Phone/Fax

Practice location:
  • Phone: 337-267-4262
  • Fax:
Mailing address:
  • Phone: 337-267-4262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRY J RUDOLPH JR.
Title or Position: NATUROPATH
Credential:
Phone: 337-267-4262