Provider Demographics
NPI:1124149554
Name:RUDESEAL CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:RUDESEAL CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:RUDESEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:409-883-3942
Mailing Address - Street 1:1312 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-4949
Mailing Address - Country:US
Mailing Address - Phone:409-883-3942
Mailing Address - Fax:409-883-3108
Practice Address - Street 1:1312 W PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4949
Practice Address - Country:US
Practice Address - Phone:409-883-3942
Practice Address - Fax:409-883-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124105135OtherNPI FOR RONALD RUDESEAL
TX1198947-01Medicaid
TX00J09AMedicare ID - Type UnspecifiedCLINIC PROVIDER NUMBER
TX1198947-01Medicaid
TX86M700Medicare ID - Type UnspecifiedPROVIDER NUMBER