Healthcare Provider Details

I. General information

NPI: 1649298217
Provider Name (Legal Business Name): RODULFO CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 LAWNDALE DR
GREENSBORO NC
27455-1889
US

IV. Provider business mailing address

4113 LAWNDALE DR
GREENSBORO NC
27455-1889
US

V. Phone/Fax

Practice location:
  • Phone: 336-660-0019
  • Fax: 336-235-0754
Mailing address:
  • Phone: 336-235-4530
  • Fax: 336-235-0754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3242
License Number StateNC

VIII. Authorized Official

Name: DR. DAMIEN JUDE RODULFO
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 336-235-4530