Provider Demographics
NPI:1942607395
Name:RORABAUGH-IRWIN, JOSEPH RANDALL (RD, LD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RANDALL
Last Name:RORABAUGH-IRWIN
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:RORABAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:2415 MASSACHUSETTS ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-4827
Mailing Address - Country:US
Mailing Address - Phone:785-832-4866
Mailing Address - Fax:
Practice Address - Street 1:2415 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-4827
Practice Address - Country:US
Practice Address - Phone:785-832-4866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1756133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered