Provider Demographics
NPI:1912051277
Name:HEUCHERT, RUDOLPH (DC)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:
Last Name:HEUCHERT
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 1:11107 SE STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-4454
Mailing Address - Country:US
Mailing Address - Phone:503-252-9576
Mailing Address - Fax:593-353-8267
Practice Address - Street 1:11107 SE STANLEY AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-4454
Practice Address - Country:US
Practice Address - Phone:503-252-9576
Practice Address - Fax:593-353-8267
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230019Medicaid
OR230019Medicaid