Provider Demographics
NPI:1407838675
Name:RODULFO, DAMIEN JUDE (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:DAMIEN
Middle Name:JUDE
Last Name:RODULFO
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 W CORNWALLIS DR STE C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7098
Mailing Address - Country:US
Mailing Address - Phone:336-235-4530
Mailing Address - Fax:336-235-0754
Practice Address - Street 1:2105 W CORNWALLIS DR STE C
Practice Address - Street 2:A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7098
Practice Address - Country:US
Practice Address - Phone:336-235-4530
Practice Address - Fax:336-235-0754
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3242111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085UROtherBCBS NUMBER
NC89085URMedicaid
NC89085URMedicaid
NC085UROtherBCBS NUMBER