Provider Demographics
NPI:1649298217
Name:RODULFO CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:RODULFO CHIROPRACTIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:RODULFO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-235-4530
Mailing Address - Street 1:4113 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1889
Mailing Address - Country:US
Mailing Address - Phone:336-235-4530
Mailing Address - Fax:336-235-0754
Practice Address - Street 1:4113 LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-1889
Practice Address - Country:US
Practice Address - Phone:336-660-0019
Practice Address - Fax:336-235-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3242111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085UROtherBCBS
NC89085URMedicaid
NC085UROtherBCBS
NC89085URMedicaid