Provider Demographics
NPI:1700989787
Name:RUNDLE, PAUL FRANK (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FRANK
Last Name:RUNDLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3450
Mailing Address - Country:US
Mailing Address - Phone:304-367-1131
Mailing Address - Fax:304-367-1141
Practice Address - Street 1:2703 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3450
Practice Address - Country:US
Practice Address - Phone:304-367-1131
Practice Address - Fax:304-367-1141
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV11430994OtherCAQH
WV3810002055Medicaid
WV4282386OtherCIGNA HEALTHCARE
WVWV00820OtherTHE HEALTH PLAN
WV3810002055Medicaid
WV4151601Medicare PIN