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General NPI Number Information
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NPI Number | 1316142250
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Entity Type | Individual
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Provider Name | GERALD D RUDOLPH D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 1408 ELMWOOD AVE
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City | COLUMBIA
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State | SC
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Zip | 29201-2110
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Country | US
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Telephone | 803-376-6293
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Fax | 803-376-6294
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Provider Business Mailing Address
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Address Line | 3017 LEMANS
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City | COLUMBIA
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State | SC
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Zip | 29209-5223
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Country | US
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Telephone | 803-776-0389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3256
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License Number State | SC
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