Provider Demographics
NPI:1306140108
Name:RUDOLPH, TERRY JOHN JR (ND)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JOHN
Last Name:RUDOLPH
Suffix:JR
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-7700
Mailing Address - Country:US
Mailing Address - Phone:337-366-7887
Mailing Address - Fax:
Practice Address - Street 1:220 RIVER RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-7700
Practice Address - Country:US
Practice Address - Phone:337-366-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath