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General NPI Number Information
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NPI Number | 1124149554
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Entity Type | Organization
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Legal Business Name | RUDESEAL CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 1312 W PARK AVE
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City | ORANGE
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State | TX
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Zip | 77630-4949
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Country | US
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Telephone | 409-883-3942
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Fax | 409-883-3108
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Provider Business Mailing Address
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Address Line | 1312 W PARK AVE
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City | ORANGE
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State | TX
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Zip | 77630-4949
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Country | US
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Telephone | 409-883-3942
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Fax | 409-883-3108
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD WAYNE RUDESEAL
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Credential | D.C.
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Telephone | 409-883-3942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4296
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License Number State | TX
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