MEDICARE: DR. RONALD WAYNE RUDESEAL DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4296	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4545346	OTHER	TX	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	629865	OTHER	TX	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1124105135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD WAYNE RUDESEAL DC

Provider Business Mailing Address
First Line	:	1312 WEST PARK AVENUE
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-4949
Country	:	US
Telephone Number	:	409-883-3942
Fax Number	:	409-883-3108

Provider Business Practice Location Address
First Line	:	1312 W PARK AVE
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-4949
Country	:	US
Telephone Number	:	140-988-3394
Fax Number	:	409-883-3108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/17/2021

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