Provider Demographics
NPI:1316946510
Name:RUMBAUGH, RONALD CHARLES (DC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:CHARLES
Last Name:RUMBAUGH
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 1:505 N PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3220
Mailing Address - Country:US
Mailing Address - Phone:724-628-8170
Mailing Address - Fax:724-628-0611
Practice Address - Street 1:505 N PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3220
Practice Address - Country:US
Practice Address - Phone:724-628-8170
Practice Address - Fax:724-628-0611
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJ-001179-P111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0619829 PAMedicaid
PA0619829 PAMedicaid
T28957Medicare UPIN