Provider Demographics
NPI:1639415615
Name:RAMBOLDT, WENDY ARRON (DC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ARRON
Last Name:RAMBOLDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 OSAGE BEACH PKWY
Mailing Address - Street 2:SUITE 9
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-8732
Mailing Address - Country:US
Mailing Address - Phone:573-348-2649
Mailing Address - Fax:
Practice Address - Street 1:3715 OSAGE BEACH PKWY
Practice Address - Street 2:SUITE 9
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-8732
Practice Address - Country:US
Practice Address - Phone:573-348-2649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010033754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor