Healthcare Provider Details

I. General information

NPI: 1316946510
Provider Name (Legal Business Name): RONALD CHARLES RUMBAUGH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N PITTSBURGH ST
CONNELLSVILLE PA
15425-3220
US

IV. Provider business mailing address

505 N PITTSBURGH ST
CONNELLSVILLE PA
15425-3220
US

V. Phone/Fax

Practice location:
  • Phone: 724-628-8170
  • Fax: 724-628-0611
Mailing address:
  • Phone: 724-628-8170
  • Fax: 724-628-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberAJ-001179-P
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: