Provider Demographics
NPI:1477998268
Name:JODY L RUMBAUGH CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:JODY L RUMBAUGH CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RUMBAUGH-HAGGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-628-4334
Mailing Address - Street 1:133 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-2501
Mailing Address - Country:US
Mailing Address - Phone:724-628-4334
Mailing Address - Fax:724-628-4337
Practice Address - Street 1:133 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-2501
Practice Address - Country:US
Practice Address - Phone:724-628-4334
Practice Address - Fax:724-628-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004775L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012400200001Medicaid
PAU19003Medicare UPIN