Provider Demographics
NPI:1760630800
Name:TOMAN, RUDELLE A (DC)
Entity Type:Individual
Prefix:DR
First Name:RUDELLE
Middle Name:A
Last Name:TOMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:RUDELLE
Other - Middle Name:
Other - Last Name:GILLINGWATORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 11056
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-1056
Mailing Address - Country:US
Mailing Address - Phone:307-733-7765
Mailing Address - Fax:
Practice Address - Street 1:242 E. BROADWAY AVE.
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-733-7765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor