Provider Demographics
NPI:1952400558
Name:SASINA, RUDOLPH CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:CHARLES
Last Name:SASINA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RUDY
Other - Middle Name:CHARLES
Other - Last Name:SASINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:108 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67068
Mailing Address - Country:US
Mailing Address - Phone:620-532-2225
Mailing Address - Fax:620-532-3621
Practice Address - Street 1:108 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068
Practice Address - Country:US
Practice Address - Phone:620-532-2225
Practice Address - Fax:620-532-3621
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062043Medicare ID - Type Unspecified