Provider Demographics
NPI:1124105135
Name:RUDESEAL, RONALD WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WAYNE
Last Name:RUDESEAL
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 1:1312 WEST PARK AVENUE
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:140-988-3394
Practice Address - Fax:409-883-3108
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4545346OtherAETNA
TXZ000J09AMedicaid
TX629865OtherUNITED HEALTHCARE
TX00J09AMedicare ID - Type Unspecified
86M700Medicare ID - Type Unspecified
TX629865OtherUNITED HEALTHCARE