Provider Demographics
NPI:1659405868
Name:RUMPH CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:RUMPH CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:RUMPH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-673-1215
Mailing Address - Street 1:5732 WILLIAMS LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-3274
Mailing Address - Country:US
Mailing Address - Phone:248-673-1215
Mailing Address - Fax:248-673-7027
Practice Address - Street 1:5732 WILLIAMS LAKE ROAD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3274
Practice Address - Country:US
Practice Address - Phone:248-673-1215
Practice Address - Fax:248-673-7027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301002727OtherCOMMERCIAL
MI950F318420OtherBCBSM