Theobald, Rudolph A.
Theobald, Rudolph A. is an sole proprietor health care provider with primary practice located at 6024 Soutwest Blvd , Fort Worth TX 76109. He recently has only one registered license in Chiropractic Providers / Rehabilitation, which is considered as his primary health care specialty. Theobald, Rudolph A. can be contacted via phone (817) 665-5495.Contact Information
Primary practice address
6024 Soutwest Blvd
Fort Worth TX 76109
Phone: (817) 665-5495
Fax: (817) 524-6194
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Rehabilitation | 111NR0400X | 8869 | Texas |
Profile Details
| NPI number | 1386729929 |
|---|---|
| LBN Legal business name | Theobald, Rudolph A. |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 25th, 2006 |
| Last updated | Jun 21st, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1386729929 | NPPES |
| Texas | Other | 11384841 | CAQH |
| Texas | MEDICAID | 149696001 | CAQH |
| Texas | Other | 1997117 | CAQH |
| Texas | Other | 606350 | CAQH |
| Texas | Other | 104065 | CAQH |
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