Provider Demographics
NPI:1396742276
Name:RUMBAUGH, JODY LYNN (DC)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LYNN
Last Name:RUMBAUGH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:JODY
Other - Middle Name:LYNN
Other - Last Name:RUMBAUGH-HAGGERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
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:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-004775-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1240020Medicaid
U19003Medicare UPIN
PA1240020Medicaid